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Oklahoma rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $38.02 / $75.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.55
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.26 / $1.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.69 / $4.27 / $6.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $1.26 / $1.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $2.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.48 / $2.29 / $75.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.48 / $1.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.58