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Washington rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Facilitymedian $9 · 10th–90th $2$3980%5%10%10th90th$9Professionalmedian $1 · 10th–90th $1$20%20%40%10th90th$1$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.51 / $9.12 / $398.11
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $2.69
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.35 / $1.35 / $1.35
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.35 / $1.35 / $1.35
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.78 / $1.78 / $6.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.35 / $1.35 / $1.66
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.38 / $1.38 / $3.80
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.24 / $4.37 / $4.37
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.62 / $2.24 / $2.24
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.35 / $1.35 / $1.35
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.35 / $1.35 / $1.35
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.58 / $1.58 / $3.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.32 / $1.32 / $1.58
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.32 / $1.35 / $1.78