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Nebraska rates for HCPCS J1645

Injection Dalteparin Sodium Per 2500 Iu (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.04 / $27.17 / $36.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.54 / $18.04 / $30.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.05 / $17.79 / $18.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $18.73 / $20.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.35 / $16.54 / $20.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.61 / $38.97 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.04 / $18.04 / $19.84
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.48 / $19.25 / $21.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.78 / $18.41 / $32.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.71 / $16.54 / $18.19