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Pennsylvania 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 / $6.11 / $7.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.63 / $5.92
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.41 / $2.83 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.71 / $2.71 / $2.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.46 / $2.61 / $2.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.64 / $5.19 / $7.93
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.64 / $7.93
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.46 / $2.61 / $2.61
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.38 / $2.38 / $2.77
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.38 / $2.38 / $2.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $3.69