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Nebraska rates for HCPCS J2503

Injection, pegaptanib sodium, 0.3 mg

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,194.00 / $1,194.00 / $1,194.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$844.80 / $862.59 / $889.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.25 / $800.25 / $1,000.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$767.78 / $4,966.62 / $4,966.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.25 / $889.25 / $978.18
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$889.98 / $1,137.43 / $1,596.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.80 / $1,137.43 / $1,840.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.33 / $889.25 / $889.25