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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
$2.61 / $2.61 / $4.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $3.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.83 / $2.84 / $2.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.35 / $2.84 / $2.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $2.58 / $3.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.46 / $2.61 / $4.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.61 / $2.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.61 / $3.10