go back

Oklahoma 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 / $2.82 / $4.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.82 / $2.82 / $2.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.24 / $1.94 / $3.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.46 / $2.46 / $2.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.61 / $2.82 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.61 / $2.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.77