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New Mexico rates for HCPCS J0743

Cilastatin Sodium Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.25 / $10.87 / $10.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.76 / $13.01 / $16.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,799.99 / $68,899.99 / $81,099.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.12 / $7.12 / $7.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.63 / $12.09 / $16.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25