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New York 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 / $7.44 / $29.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $2.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $4.30
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.73 / $2.73 / $2.87
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.73 / $2.73 / $2.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.31 / $2.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.97 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $1.51 / $3.64
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.44
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.44
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.99 / $4.54 / $9.06
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.31 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $2.57 / $7.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $3.22
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.44 / $1.44 / $1.44
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.44 / $2.57