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Nebraska rates for HCPCS J1428

Inj, eteplirsen, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.60 / $334.93 / $424.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.60 / $153.60 / $257.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.01 / $163.19 / $200.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.00 / $291.83 / $837.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.00 / $160.00 / $192.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.16 / $192.16 / $192.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.16 / $192.16 / $192.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.00 / $160.00 / $176.00