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Pennsylvania rates for HCPCS 80177

Levetiracetam

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.90 / $54.72 / $93.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.02 / $9.59 / $13.25
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.63 / $7.95 / $13.25
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.45 / $28.80 / $799.52
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.48 / $81.13 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.34 / $10.34 / $10.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.71 / $17.22 / $38.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.77 / $15.28 / $21.16
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.10 / $10.60 / $17.94
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.12 / $31.15 / $62.93
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.95 / $10.23 / $12.50
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.25 / $25.84 / $60.85
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.55 / $45.24 / $115.50
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.02 / $10.47 / $54.72
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.86 / $20.53 / $43.46
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.77 / $15.28 / $21.16
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.25 / $13.25 / $19.89
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.66 / $13.25 / $19.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.96 / $8.61 / $23.06