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New Hampshire 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 / $39.49 / $63.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $63.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.16 / $113.51 / $286.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.09 / $63.06 / $63.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.49 / $63.06 / $63.06
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
$66.16 / $102.41 / $194.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $66.84
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.67 / $326.74 / $493.46