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Indiana rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.84 / $68.54 / $350.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.41 / $1.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.46 / $2.78 / $4.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.18 / $1.39 / $1.97
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.39 / $1.39 / $2.06
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $5.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $2.36