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Montana rates for HCPCS J0742

Injection Imipenem 4 Mg Cilastatin 4 Mg And Relebactam 2 Mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.84 / $3.16 / $5.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.87 / $2.87 / $2.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.87 / $2.87 / $2.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.83 / $3.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61