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Nebraska rates for HCPCS J9268

Pentostatin Per 10 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,543.89 / $2,608.16 / $5,765.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $4,269.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,509.79 / $2,952.70 / $2,952.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,735.94 / $2,879.94 / $2,952.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $3,459.34 / $4,208.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,273.15 / $3,688.64 / $4,960.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,543.89 / $2,696.52 / $3,815.84
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,352.08 / $3,815.84 / $4,773.62
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,148.64 / $3,208.12 / $4,208.10
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,613.50 / $3,051.54 / $5,320.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,432.82 / $3,261.58 / $7,084.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $3,103.71