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Vermont rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.48 / $11.48 / $11.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $11.48 / $11.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $7.08 / $10.96