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New Mexico rates for HCPCS J2810

Injection, theophylline, per 40 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.41 / $0.47
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.05