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New Mexico rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.84 / $26.86 / $100.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $24.12 / $57.35
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
$20.30 / $29.01 / $29.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.11 / $19.84 / $29.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84