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Utah rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.09 / $11.89 / $11.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.89 / $11.89 / $11.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.42 / $10.47 / $11.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25