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South Dakota 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
$63.06 / $63.06 / $63.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.83 / $63.06 / $233.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.46 / $82.46 / $103.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.89 / $87.93 / $287.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.09 / $35.72 / $90.13
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.50 / $121.32 / $239.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.20 / $150.43 / $253.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.01 / $69.01 / $69.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $70.20
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.09 / $32.09 / $32.09
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.09 / $32.09 / $32.09