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Utah 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
$73.15 / $73.15 / $776.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.15 / $73.15 / $73.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.61 / $115.55 / $157.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $63.06
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.09 / $216.44 / $321.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.91 / $63.06 / $70.20