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North Dakota 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
$2.00 / $2.00 / $4.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $3.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.82 / $2.82 / $2.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.82 / $2.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $2.63 / $3.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.45 / $2.51 / $4.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.51 / $2.63 / $2.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.19 / $2.57 / $2.88