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Iowa 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
$48.44 / $287.97 / $287.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $70.05 / $287.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.46 / $97.15 / $103.08
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $114.14 / $495.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.08 / $97.15 / $287.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.09 / $35.72 / $253.79
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.50 / $141.54 / $239.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.50 / $182.53 / $390.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $75.04
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.09 / $32.09 / $32.09
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.09 / $32.09 / $32.09