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Nebraska rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.97 / $10.99 / $22.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.97 / $10.25 / $16.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.69 / $11.02 / $11.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.50 / $11.02 / $11.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.46 / $9.33 / $10.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.28 / $18.14 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.97 / $6.97 / $10.46
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.55 / $8.80 / $11.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.82 / $8.60 / $14.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.74 / $10.25 / $15.38