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Pennsylvania rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.04 / $16.30 / $21.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.43 / $10.25 / $16.57
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.44 / $11.12 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.63 / $10.63 / $10.63
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
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.68 / $9.68 / $9.68
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.04 / $11.90 / $21.19
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.04 / $10.35 / $21.19
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.67 / $10.25 / $10.25
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.23 / $8.23 / $9.55
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.23 / $8.23 / $9.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $15.83