go back

California rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $14.79 / $20.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $20.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.76 / $10.72 / $16.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.23 / $10.72 / $25.70
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.22 / $12.59 / $16.98
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $9.12 / $21.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $6.76 / $7.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.08
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $7.76 / $16.22
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.24 / $7.24 / $7.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.61 / $11.48 / $19.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.31 / $6.31 / $12.88
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $11.22 / $11.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $20.42 / $20.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $19.05