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New York rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.97 / $10.25 / $13.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.43 / $10.25 / $10.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.15 / $10.25 / $13.01
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.35 / $7.35 / $7.72
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.35 / $7.35 / $7.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.00 / $9.67 / $9.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.67 / $14.51 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.12 / $11.12 / $15.00
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.63
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.63
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.00 / $9.67 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.79 / $10.25 / $14.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $18.62
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.63 / $10.63 / $10.63
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.96 / $10.25 / $12.43