go back

Michigan rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.18 / $10.55 / $22.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.18 / $10.25 / $10.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.65 / $22.80 / $43.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.38 / $5.66 / $5.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.37 / $10.25 / $15.15
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.18 / $14.00 / $19.98
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.18 / $10.25 / $12.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.01 / $8.44 / $11.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $12.30