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Wyoming rates for HCPCS J0743

Injection, cilastatin sodium; imipenem, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.97 / $6.97 / $6.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.97 / $6.97 / $10.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.03 / $14.15 / $14.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.67 / $9.67 / $9.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $14.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.25 / $10.25 / $10.25