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Arizona rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.74 / $14.04 / $30.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.67 / $11.27 / $16.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.95 / $27.62 / $48.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.63 / $6.74 / $65.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.67 / $10.25 / $10.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.34 / $10.97 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.97 / $6.97 / $6.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25