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Texas 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 / $4.09 / $5.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.63 / $3.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.13 / $5.39 / $10.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.60 / $2.60 / $4.38
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $85.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.61 / $3.73 / $3.85
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.96 / $2.61 / $4.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.46 / $2.61 / $3.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.61 / $4.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.50 / $3.52