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Washington rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.53 / $9.57 / $479.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.53 / $2.36
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.39 / $2.48 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.78 / $5.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.31 / $3.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.71
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.39 / $1.74 / $3.56
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.48 / $4.38 / $4.38
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.89 / $5.04
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39