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New Hampshire rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Facilitymedian $9 · 10th–90th $1$790%10%10th90th$9Professionalmedian $1 · 10th–90th $1$30%20%10th90th$1$1.0$5.0$20.0$100.0$500.0

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
$1.32 / $9.33 / $79.43
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.91 / $2.82 / $4.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.32 / $1.35 / $1.51
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.51 / $2.69 / $3.72
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.35 / $1.35 / $1.35
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.35 / $2.34 / $2.57
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.32 / $1.32 / $3.02