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Rhode Island rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.51 / $11.00 / $104.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.49 / $1.49 / $4.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.39 / $1.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $9.02