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Alaska rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.23 / $43.09 / $111.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $2.59 / $6.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.70 / $3.70 / $58.38
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $4.48
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.48 / $7.06 / $11.09
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.93 / $8.40 / $19.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $2.09 / $2.80