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North Carolina rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.26 / $25.82 / $90.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $2.17 / $4.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.63 / $6.58 / $6.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.49 / $1.49 / $2.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $5.04
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.65 / $2.17 / $5.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.10 / $2.10 / $2.10
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,051.60 / $2,051.60 / $4,910.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.83
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00