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South Dakota rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Facilitymedian $19 · 10th–90th $1$890%10%20%10th90th$19Professionalmedian $1 · 10th–90th $1$20%20%40%10th90th$1$1.0$5.0$20.0$100.0

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 / $33.88 / $89.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.45
Avera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.58 / $1.58 / $1.66
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.35 / $1.35 / $1.70
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.95 / $2.51 / $4.57
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.32 / $1.48 / $1.58
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.78 / $1.78 / $1.78
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.45 / $1.45 / $1.45
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.32 / $1.32 / $2.14
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.32 / $1.32 / $1.38