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Maine 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
$65.56 / $146.30 / $157.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.83 / $63.06 / $70.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.02 / $76.59 / $199.84
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 / $80.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $63.06
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $76.37
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.30 / $146.30 / $157.65
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.83 / $65.58 / $157.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $218.22