Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm
What Medicare pays for J0295, what providers bill, and how the price varies across 17 states, drawn from CMS 2023 claims data.
J0295 · the short answer
For injection, ampicillin sodium/sulbactam sodium, per 1.5 gm, Medicare pays about $1.60 on average across 17 states. This is a low-payment administrative or drug code, so the billed-to-paid ratio is not a meaningful "markup."
- Medicare pays
- $1.60
- Providers bill
- $10.91
- States with data
- 17
Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Drugs (Administered) procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Illinois | $1.72 | $12.18 |
| Oregon | $1.66 | $4.27 |
| Arizona | $1.64 | $16.81 |
| California | $1.64 | $9.71 |
| Georgia | $1.63 | $41.72 |
| Florida | $1.63 | $10.12 |
| Virginia | $1.63 | $26.41 |
| Nevada | $1.62 | $8.78 |
| Massachusetts | $1.61 | $11.14 |
| Rhode Island | $1.61 | $5.15 |
| Alabama | $1.60 | $5.19 |
| Missouri | $1.59 | $10.00 |
| Arkansas | $1.56 | $46.67 |
| New York | $1.54 | $11.24 |
| Colorado | $1.53 | $20.67 |
| Mississippi | $1.45 | $18.47 |
| New Jersey | $1.22 | $8.36 |
What the Data Says About Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm
Across 17 states with reporting providers, CPT code J0295 (Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm) shows a national average Medicare payment of $1.60 against an average billed charge of $10.91. That gap, a 6.8x markup, or 580% above the Medicare allowed amount, is not a meaningful ratio for this low-payment code, so treat the billed figure as a chargemaster reference point rather than a real-world price.
Drugs (Administered) procedures like this one saw 5.9K services billed to Medicare in 2023 by 334 distinct providers, serving 551 unique beneficiaries. State-level variation is significant: New Jersey reports the lowest average payment at $1.22, while Illinois reports the highest at $1.72. The 41% spread here is a moderate, fairly ordinary GPCI effect, local cost-of-practice adjustments nudging the allowed amount up or down without reshaping it.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Drugs (Administered) category (2.24x), the estimated commercial insurance price lands near $4.55, with self-pay cash discounts commonly bringing the figure closer to $4.53. Within Drugs (Administered), Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm ranks #403 of 530 tracked procedures by national average Medicare payment.
What to do with this
If you may have injection, ampicillin sodium/sulbactam sodium, per 1.5 gm done, these steps turn the numbers above into a real-world cost estimate.
- Request a Good Faith Estimate from your provider at least 3 business days before a scheduled procedure, under the No Surprises Act it is an enforceable written price.
- Compare injection, ampicillin sodium/sulbactam sodium, per 1.5 gm costs in your state, Medicare rates vary by locality. Browse states
- Check a hospital’s published cash price, which is often far below the billed charge. Price transparency
- Understand why billed charges run several times the Medicare rate before you negotiate. Read the guide
Figures here are averages and estimates, not a quote. Confirm coverage and out-of-pocket costs with your insurer and provider.
Frequently Asked Questions
How much does Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm cost?
Medicare's national average payment for Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm (CPT J0295) is $1.60, with providers billing $10.91 on average; state rates run from $1.22 to $1.72, a meaningful but not extreme spread.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm cost with insurance?
With commercial insurance, injection, ampicillin sodium/sulbactam sodium, per 1.5 gm costs an estimated $4.55 on average (range: $3.19-$6.37), a moderate premium over Medicare's $1.60. Without insurance, the estimated cash price is $4.53.
Which state has the lowest cost for Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm?
New Jersey has the lowest average Medicare payment for Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm at $1.22, while Illinois has the highest at $1.72 - a meaningful $0.50 spread.
How many providers perform Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm?
Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm is comparatively uncommon: only 334 providers nationally billed Medicare for it in 2023, serving 551 beneficiaries via 5.9K total services.
What is the billed-to-Medicare markup for Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm?
Providers bill 6.8x what Medicare pays for Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm - a markup within the typical range at 580% above the Medicare rate.
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error.