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North Dakota rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.39 / $49.24 / $215.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.52 / $1.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.14 / $1.52 / $1.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.61 / $2.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $6.04 / $22.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.49 / $1.49 / $1.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.18 / $1.39 / $2.02