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South Carolina rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.83 / $10.76 / $29.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.12 / $10.76 / $11.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.68 / $21.04 / $26.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.69 / $9.81 / $12.81
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 / $10.25
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.83 / $11.84 / $21.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $11.28