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New Hampshire rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $9.33 / $79.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.86 / $2.75 / $4.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.51
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 / $1.32
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $2.24 / $2.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $2.95