go back

Louisiana rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $28.12 / $188.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.41 / $1.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $2.59 / $8.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.73 / $1.76
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.25 / $21.25 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.31 / $1.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $2.90