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Wisconsin rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Facilitymedian $68 · 10th–90th $3$1700%10%10th90th$68Professionalmedian $1 · 10th–90th $1$30%20%10th90th$1$1.0$5.0$20.0$100.0

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
$3.98 / $72.44 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $2.57
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.70 / $1.70 / $1.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.35 / $1.35 / $1.70
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.82 / $4.17 / $7.24
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.35 / $1.70 / $2.45
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.38 / $1.38 / $2.88
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.09 / $2.75 / $3.24
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.48 / $21.88 / $43.65
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.48 / $1.48 / $2.75
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.32 / $64.57 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.86 / $1.86 / $1.86
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.35 / $1.78 / $4.79
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.32 / $1.32 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.32 / $1.32 / $1.32
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.82 / $1.82 / $3.24
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.58 / $1.58 / $3.63
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.32 / $1.32 / $2.00