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Missouri rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.70 / $42.66 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $16.22
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $2.24 / $3.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.38 / $1.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $1.32 / $1.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.66 / $8.32 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.17 / $1.48 / $1.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.58 / $2.09 / $2.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.32 / $1.66