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Maine 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
$6.06 / $6.06 / $6.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.71 / $3.16 / $3.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.52 / $3.17 / $8.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $3.16
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.06 / $6.06 / $6.53
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.71 / $3.16 / $6.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.61 / $3.92