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Nebraska rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.49 / $3.17 / $220.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.49 / $6.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.19 / $1.58 / $1.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $1.58 / $1.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.34 / $2.34 / $2.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.61 / $2.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.83 / $30.46 / $98.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.49 / $3.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.87 / $2.74 / $3.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.79 / $2.74 / $6.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.39 / $1.53