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Washington 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
$2.73 / $3.34 / $5.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.87 / $3.16
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.46 / $3.78 / $7.31
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.64 / $3.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.46 / $2.46 / $5.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $3.20
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.61 / $3.26 / $7.83
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.22 / $3.94 / $6.89
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.71 / $2.95
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $3.02 / $5.61
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.61 / $2.61