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Texas rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.28 / $27.47 / $239.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.41 / $2.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.14 / $7.94 / $15.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.19 / $3.19 / $7.82
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.49 / $2.00 / $47.32
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.25 / $21.25 / $21.25
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $2.04 / $28.03
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.39 / $2.97
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$505.94 / $747.03 / $2,207.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.39 / $2.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.39 / $2.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.49 / $1.64 / $1.88