go back

Virginia rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.05 / $52.88 / $157.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.46 / $1.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.65 / $3.02 / $4.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.31 / $1.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.18 / $1.67 / $5.90
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.39 / $1.39 / $6.30
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1.68 / $4.79
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.68 / $4.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.74