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Indiana rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.04 / $16.70 / $31.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.35 / $10.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.76 / $20.50 / $30.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.71 / $10.25 / $14.55
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.25 / $10.25 / $13.84
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $12.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.23 / $10.25 / $19.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $14.71