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Connecticut 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
$41.48 / $70.63 / $189.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.58 / $65.58 / $65.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.93 / $105.08 / $254.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $63.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.06 / $63.06 / $63.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $63.06
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.44 / $68.41 / $78.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $69.37 / $258.35