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Alaska rates for HCPCS J0742

Injection, imipenem 4 mg, cilastatin 4 mg and relebactam 2 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.73 / $4.80 / $17.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.64 / $4.84 / $6.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.94 / $6.94 / $6.94
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $8.40
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.78 / $4.13 / $6.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.79 / $5.90 / $9.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $3.92 / $5.26