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New Mexico rates for HCPCS J1205

Injection, chlorothiazide sodium, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.43 / $39.45 / $62.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $50.10 / $143.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.36 / $674.76 / $1,711.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.49 / $124.49 / $124.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.24 / $154.06 / $447.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45