go back

South Dakota rates for HCPCS 80177

Levetiracetam

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.48 / $75.86 / $186.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $12.02 / $79.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $25.70 / $25.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $25.70 / $31.62
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.59 / $21.38 / $63.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $9.33 / $18.20
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $31.62 / $36.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.62 / $9.33 / $18.20
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $13.18