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Tennessee rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.43 / $16.20 / $97.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.04 / $5.04 / $5.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $3.54