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California 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
$50.06 / $74.61 / $664.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.83 / $63.06 / $233.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.54 / $100.73 / $225.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.09 / $52.62 / $388.35
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.00 / $100.00 / $336.92
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.06 / $46.06 / $130.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.49 / $59.49 / $63.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $63.06
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.75 / $75.67 / $168.37
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.86 / $999.65 / $999.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.49 / $63.06 / $91.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $136.40
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.87 / $355.87 / $355.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $66.84 / $169.36