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Nebraska rates for HCPCS J2810

Injection, theophylline, per 40 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.75 / $0.90 / $1.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.79 / $1.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.45 / $0.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.47 / $0.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.41 / $0.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.47 / $100.00 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.05 / $1.05
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.38 / $0.48 / $0.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.47 / $0.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.05 / $1.05