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Kentucky rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.39 / $9.74 / $104.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.57 / $1.64 / $1.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.18 / $1.39 / $1.39
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.39 / $1.53 / $2.22
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.46 / $2.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.39 / $1.39 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $2.58 / $8.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39