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Montana rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Facilitymedian $36 · 10th–90th $2–$3090%10%20%10th90th$36Professionalmedian $1 · 10th–90th $1–$50%20%40%10th90th$1$1.0$10.0$100.0$1.0K$10.0K$100.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20.42 / $74.13 / $309.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $4.90
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.31 / $46,773.51 / $91,201.08
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.78 / $1.78 / $8.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.35 / $1.35 / $1.78
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.24 / $2.24 / $5.37
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.24 / $2.24 / $5.37
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.78 / $1.78 / $8.13
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.35 / $1.91 / $85.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.32 / $1.32 / $1.32