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New Hampshire rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.97 / $7.81 / $13.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.81 / $10.25 / $10.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.25 / $15.38 / $42.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.97 / $10.25 / $10.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.67 / $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
$13.91 / $17.07 / $31.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.32 / $13.89 / $20.28