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Idaho rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.49 / $17.22 / $95.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.53 / $1.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.39 / $1.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.53 / $1.96 / $20.21
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $5.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.57 / $1.57 / $1.57
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.67 / $1.67 / $1.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $2.22