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Pennsylvania rates for HCPCS J1190

Injection, dexrazoxane HCl, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.51 / $75.09 / $809.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.00 / $63.69 / $333.83
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.15 / $68.41 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.44 / $65.44 / $65.44
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
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.87 / $853.13 / $1,181.67
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.40 / $79.58 / $2,130.60
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.40 / $63.69 / $97.55
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.49 / $63.06 / $63.06
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $63.06
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.25 / $125.25 / $145.34
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.25 / $125.25 / $145.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $66.84 / $115.40