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Virginia rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $10.76 / $18.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.76 / $10.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.44 / $10.76 / $16.23
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.71 / $12.30 / $18.62
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.25 / $12.38 / $17.87
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.00 / $8.00 / $8.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.74 / $11.33 / $13.44
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.74 / $11.33 / $13.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.94 / $10.25 / $12.86