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South Carolina rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $60.26 / $95.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $6.31
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.17 / $1.17 / $1.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $8.32 / $10.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.91 / $4.27
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $2.00 / $10.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.58