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New Mexico rates for HCPCS J1558

Injection, immune globulin (xembify), 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.85 / $23.24 / $23.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $18.85 / $37.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.84 / $14.84 / $14.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.84 / $14.84 / $14.84
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.30 / $14.84 / $14.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.84 / $14.84 / $14.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.85 / $14.85