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Texas rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.25 / $12.81 / $73.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.35 / $11.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.59 / $8.94 / $17.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.49 / $4.49 / $9.94
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.97 / $14.66 / $15.24
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.23 / $10.25 / $18.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.67 / $10.25 / $15.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $10.25 / $13.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.97 / $7.20 / $13.84