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Washington rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.80 / $13.12 / $16.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.43 / $10.25 / $11.27
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.49 / $10.25 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.27 / $10.25 / $14.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.67 / $9.67 / $14.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $12.57
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.97 / $10.63 / $21.32
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.49 / $10.70 / $10.70
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.06 / $7.81 / $12.89
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25
Regence BlueShield
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