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California rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.66 / $43.25 / $164.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.41 / $6.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $1.60 / $2.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.49 / $6.01
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.62 / $4.28 / $7.61
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.53 / $1.53 / $4.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.31 / $1.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.67 / $3.71
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.39 / $2.02
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $3.01
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.70 / $4.70 / $4.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $3.81