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New York 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 / $3.18 / $5.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $3.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.09 / $2.09 / $2.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.61 / $2.61
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.31 / $2.31 / $2.43
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.31 / $2.31 / $2.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.39 / $2.46 / $2.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.46 / $3.69 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.83 / $2.83 / $3.37
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.71
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.71
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.39 / $2.46 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $3.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $3.66
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.71 / $2.71 / $2.71
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.71