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Louisiana rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.97 / $10.25 / $15.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.97 / $10.25 / $10.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $12.11 / $15.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.23
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.67 / $9.67 / $10.25
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 / $10.25 / $17.48