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Nebraska 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 / $5.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $5.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.21 / $2.80 / $2.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.79 / $2.91 / $2.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $2.61 / $3.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.46 / $2.61 / $85.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.61 / $2.87
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.00 / $4.03 / $5.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.86 / $3.13 / $5.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.48 / $2.61 / $3.03