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Wisconsin 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
$33.04 / $64.18 / $1,595.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $64.95 / $96.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.83 / $116.66 / $140.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $80.08
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.34 / $86.34 / $100.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.06 / $212.39 / $303.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.46 / $168.45 / $191.43
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.09 / $32.09 / $203.03
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.14 / $126.12 / $126.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.08 / $32.09 / $203.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.09 / $35.72 / $126.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $80.95 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.09 / $32.09 / $203.03
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.14 / $126.12 / $126.12
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $98.16 / $283.89
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.06 / $63.06 / $999.65
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $63.06
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.54 / $88.54 / $349.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $70.20 / $94.59