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Arkansas rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.67 / $7.68 / $93.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.67 / $1.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.62 / $1.62 / $1.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.62 / $1.62 / $1.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.39 / $2.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $5.32