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Hawaii rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $34.67 / $512.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.32
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $1.95 / $1.95
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.58 / $1.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.95 / $2.00