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South Carolina 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
$66.20 / $239.40 / $981.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $66.20 / $233.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.95 / $377.11 / $636.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.58 / $87.00 / $279.74
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.20 / $89.38 / $329.11
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.22 / $332.22 / $332.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $66.84 / $70.20