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Illinois 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 / $94.59 / $345.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.09 / $63.06 / $80.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$589.41 / $1,072.74 / $2,536.87
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
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $150.00 / $582.50
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.98 / $81.98 / $81.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $66.84 / $109.09