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Minnesota rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.25 / $10.25 / $13.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $16.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $10.00 / $17.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.58 / $6.97 / $8.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.12 / $22.57 / $27.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.54 / $8.32 / $9.48
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.32 / $20.60 / $25.86
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.46 / $7.46 / $10.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $11.78 / $20.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.97 / $6.97 / $12.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $15.83