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Maryland rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.97 / $12.40 / $62.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.32 / $10.25 / $10.25
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.97 / $6.97 / $10.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $13.05
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $16.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $16.61
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.20 / $7.20 / $7.20