go back

Alaska rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.80 / $12.84 / $45.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.04 / $16.57 / $19.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.26 / $27.26 / $27.26
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $33.01
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.86 / $18.05 / $28.36
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.43 / $25.78 / $42.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $11.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $15.38 / $20.68