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New Mexico rates for HCPCS J1455

Injection, foscarnet sodium, per 1,000 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.07 / $24.29 / $24.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $21.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.98 / $73.26 / $119.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.56 / $13.56 / $13.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.91 / $12.72 / $36.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07