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West Virginia rates for HCPCS J1190

Injection, dexrazoxane HCl, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.40 / $63.69 / $287.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $86.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.06 / $94.59 / $94.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.49 / $63.06 / $279.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $63.06 / $275.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.06 / $70.20 / $280.81