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Minnesota rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $43.65 / $47.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.58 / $3.31 / $3.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.32 / $1.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.72 / $6.92 / $8.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.58 / $1.70
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.37 / $6.61 / $7.76
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.35 / $1.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.37 / $15.85 / $36.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $1.48 / $2.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $2.63