Quantitative levetiracetam drug screen

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

LEVETIRACETAM LEVEL

Payers reporting CPT 80177

Payer pricing summary

Low

Average

$266

Median

$50

High

$5.0k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +36 other terms	864	$13	$18	$26	144%	175–382	$1 – $771
2	Molina fee schedule · outpatient · +31 other terms	322	$15	$16	$11	70%	161–188	$1 – $215
3	Blue Cross Blue Shield fee schedule · outpatient · +34 other terms	579	$19	$34	$37	109%	79–367	$1 – $384
4	Aetna fee schedule · outpatient · +34 other terms	773	$15	$54	$337	627%	36–144	$0 – $8.4k
5	Bcbs Mt fee schedule · outpatient · +2 other terms	1	$30	$30	—	—	34	$30 – $30
6	Humana fee schedule · outpatient · +30 other terms	567	$13	$32	$47	145%	21–102	$1 – $771
7	Anthem fee schedule · outpatient · +27 other terms	243	$17	$25	$26	104%	18–180	$2 – $317
8	Caresource fee schedule · outpatient · +17 other terms	115	$15	$19	$14	73%	17–53	$1 – $79
9	Kaiser fee schedule · outpatient · +21 other terms	128	$13	$15	$16	108%	4–40	$2 – $211
10	Cigna fee schedule · outpatient · +29 other terms	533	$26	$49	$259	526%	3–30	$3 – $6.9k
11	Ambetter fee schedule · outpatient · +21 other terms	129	$21	$20	$8	39%	3–30	$9 – $69
12	Aetna Better Health fee schedule · outpatient · +19 other terms	123	$13	$14	$7	48%	2–20	$7 – $49
13	Bcbs Al facility · other · outpatient · +5 other terms	4	$15	$16	$2	11%	2–20	$14 – $18
14	Cigna Healthspring fee schedule · outpatient · +8 other terms	150	$13	$13	$1	10%	1–10	$8 – $23
15	Optum fee schedule · outpatient · +21 other terms	73	$13	$27	$29	105%	1–10	$13 – $136
16	Sanford Health Plan fee schedule · outpatient · +14 other terms	22	$34	$48	$68	140%	1–10	$13 – $442
17	WellCare fee schedule · outpatient · +22 other terms	324	$14	$15	$6	42%	—	$8 – $106
18	Devoted fee schedule · outpatient · +16 other terms	187	$13	$13	$0	2%	—	$13 – $14
19	Oscar fee schedule · outpatient · +18 other terms	168	$26	$28	$9	34%	—	$11 – $41
20	MultiPlan fee schedule · outpatient · +21 other terms	113	$119	$93	$93	101%	—	$6 – $450
21	Tricare facility · fee schedule · outpatient · +19 other terms	112	$13	$14	$9	66%	—	$5 – $93
22	First Health fee schedule · outpatient · +17 other terms	75	$13	$23	$29	124%	—	$5 – $151
23	Highmark facility · fee schedule · outpatient · +17 other terms	69	$22	$24	$14	59%	—	$9 – $75
24	Medicaid facility · fee schedule · outpatient · +16 other terms	66	$13	$13	$3	25%	—	$6 – $37
25	Superior Healthplan fee schedule · outpatient · +6 other terms	64	$14	$87	$109	125%	—	$11 – $395

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