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North Carolina rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $14.69 / $23.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.12 / $8.09 / $14.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $20.98 / $25.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.12 / $6.12 / $6.97
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 / $14.15
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $12.20 / $15.57
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.52 / $11.52 / $11.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $13.53
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00