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Illinois 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
$2.61 / $3.92 / $6.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $3.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.75 / $10.31 / $51.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $3.92 / $16.60
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.39 / $3.39 / $3.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.73