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Wyoming rates for HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 g

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.60 / $42.66 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.27 / $5.01 / $5.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $1.26 / $1.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.32