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Oklahoma rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.97 / $7.53 / $12.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.07 / $11.07 / $11.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.82 / $9.02 / $14.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.67 / $9.67 / $10.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $12.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.04 / $7.91 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.97 / $6.97 / $7.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25