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Arkansas rates for HCPCS J1190

Injection Dexrazoxane Hydrochloride Per 250 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.50 / $40.43 / $75.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $70.05 / $75.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.63 / $63.63 / $63.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.63 / $63.63 / $84.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.49 / $63.06 / $215.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $63.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $66.84 / $238.69