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Idaho rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.97 / $6.97 / $8.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.97 / $10.25 / $12.81
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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.27 / $13.58 / $18.32
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $12.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $12.30 / $12.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25