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Texas rates for HCPCS 80177

Levetiracetam

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.91 / $54.22 / $170.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.02 / $9.58 / $13.25
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.36 / $7.95 / $9.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.58 / $41.61 / $77.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $7.02 / $13.12
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.24 / $20.54 / $86.44
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.27 / $13.19 / $19.88
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.25 / $13.25 / $13.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.26 / $27.66 / $62.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.02 / $9.02 / $22.43
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.00 / $62.94 / $62.94
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.66 / $13.25 / $14.58
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.93 / $13.25 / $17.27
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.66 / $13.25 / $36.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.02 / $10.19 / $18.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.57 / $7.60 / $10.82
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.17 / $6.54 / $13.25