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New Mexico 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
$50.03 / $50.03 / $63.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $65.59 / $523.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.35 / $759.39 / $1,318.30
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.11 / $140.11 / $140.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.06 / $181.79 / $217.67
Providence
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 / $63.06