go back

Idaho 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
$32.09 / $32.09 / $52.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.83 / $63.06 / $78.83
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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.37 / $83.56 / $230.67
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $78.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.95 / $80.95 / $80.95
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.74 / $170.85 / $307.04
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.67 / $75.67 / $78.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $100.90