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Colorado rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.75 / $10.47 / $234.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $3.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.63 / $5.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $1.26 / $2.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.32
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.91 / $25.12 / $25.12
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.35 / $1.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.32