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Hawaii rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.08
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $10.47 / $10.47
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.76 / $8.51 / $10.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $8.71 / $10.72