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Vermont rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $17.78 / $17.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.58 / $1.58 / $1.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $1.58 / $1.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $2.82