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Louisiana 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 / $2.69 / $5.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.63 / $3.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $2.02 / $2.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $2.75 / $2.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.46 / $2.46 / $2.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $3.26