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Vermont rates for HCPCS J1190

Injection Dexrazoxane Hydrochloride Per 250 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.13 / $63.06 / $70.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.39 / $71.39 / $71.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.49 / $91.65 / $152.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $63.06
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.49 / $91.65 / $152.75
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $63.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.91 / $66.84 / $238.69