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Rhode Island rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.13 / $14.13 / $14.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $32.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $7.08 / $7.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $16.98