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Delaware rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.10 / $45.60 / $181.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $3.47 / $3.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.79 / $5.52 / $50.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $2.09 / $5.78