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Tennessee 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 / $3.29 / $5.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $3.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $85.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61