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West Virginia rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $12.30 / $12.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $12.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $7.08 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $43.65 / $43.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $7.08 / $15.85