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South Dakota rates for HCPCS 80177

Levetiracetam

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.46 / $108.75 / $368.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.02 / $8.88 / $72.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.11 / $26.11 / $26.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.28 / $24.15 / $30.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.70 / $21.26 / $62.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.95 / $9.27 / $18.09
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.10 / $27.01 / $37.18
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.10 / $29.45 / $37.99
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.88 / $31.92 / $36.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.57 / $11.93 / $17.48
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.25 / $13.25 / $13.25