go back

Wisconsin rates for HCPCS 80177

Levetiracetam

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $120.23 / $269.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $10.96 / $38.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $35.48 / $36.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.61 / $6.61 / $52.48
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.24 / $37.15 / $37.15
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $13.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $41.69 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $19.05 / $41.69
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $28.84 / $104.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $15.85 / $138.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.76 / $10.96 / $29.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.61 / $32.36 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $33.88 / $46.77
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.30 / $26.30 / $63.10
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $8.13
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $13.49 / $28.18
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $52.48 / $81.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $11.75 / $15.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.61 / $10.96 / $29.51