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Utah rates for HCPCS 80177

Levetiracetam

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.30 / $190.55 / $239.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $10.00 / $15.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.22 / $11.75 / $36.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.76 / $15.14 / $22.91
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $47.86 / $70.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $11.22 / $12.02
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.33 / $13.18 / $41.69
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $13.18 / $19.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.61 / $6.61 / $8.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.62 / $7.59 / $14.45