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Maine rates for HCPCS J0743

Cilastatin Sodium Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.78 / $23.78 / $25.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.43 / $8.43 / $10.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.69 / $31.69 / $31.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $12.41
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.78 / $23.78 / $25.63
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.43 / $8.43 / $25.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.02 / $10.25 / $17.94