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West 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
$7.59 / $16.60 / $64.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.38 / $2.09 / $2.09
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.24 / $3.24 / $3.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $1.32 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $8.13 / $8.13
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.31 / $4.90 / $38.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.32 / $4.90