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Delaware rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.34 / $26.34 / $26.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $16.25 / $16.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $15.38 / $18.25