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Louisiana rates for HCPCS J1190

Injection, dexrazoxane HCl, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.40 / $63.06 / $98.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.40 / $63.06 / $64.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.06 / $89.06 / $133.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.06 / $89.06 / $90.84
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $107.52