Ampicillin and sulbactam injection, 3 g at Southeast Texas - Jasper Memorial

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

ampicillin-sulbactam (Unasyn) 3 g in sodium chloride 0.9 % 100 mL IVPB

Jasper, TX

See all hospitals reporting HCPCS J0295 →

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How this price compares nationally

Southeast Texas - Jasper Memorial’s median price of $44 is 196% above the median hospital's median price ($15), higher than 81% of the 2,315 hospitals reporting HCPCS J0295. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS J0295 at Southeast Texas - Jasper Memorial

Negotiated rates from the hospital’s own file: 11 payers, 30 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	UnitedHealthcare all payer fee schedule · outpatient	$2	$2	—	—	—	$2 – $2
2	UnitedHealthcare hix fee schedule · outpatient	$2	$2	—	—	—	$2 – $2
3	Aetna new business fee schedule · outpatient	$3	$3	—	—	—	$3 – $3
4	Aetna epo fee schedule · outpatient	$3	$3	—	—	—	$3 – $3
5	Aetna hmo fee schedule · outpatient	$3	$3	—	—	—	$3 – $3
6	Aetna pos fee schedule · outpatient	$3	$3	—	—	—	$3 – $3
7	Aetna ppo fee schedule · outpatient	$3	$3	—	—	—	$3 – $3
8	Humana choicecare fee schedule · outpatient	$7	$7	—	—	—	$7 – $7
9	Bcbs Tx blue advantage hmo fee schedule · outpatient	$14	$14	—	—	—	$14 – $14
10	Bcbs Tx heb fee schedule · outpatient	$15	$15	—	—	—	$15 – $15
11	Bcbs Tx hmo fee schedule · outpatient	$15	$15	—	—	—	$15 – $15
12	Bcbs Tx ppo fee schedule · outpatient	$17	$17	—	—	—	$17 – $17
13	Bcbs Tx traditional fee schedule · outpatient	$18	$18	—	—	—	$18 – $18
14	UnitedHealthcare chip km percent of total billed charges · outpatientfrom % of charges	$21	$20	$7	34%	—	$10 – $29
15	UnitedHealthcare star kid km percent of total billed charges · outpatientfrom % of charges	$21	$20	$7	34%	—	$10 – $29
16	UnitedHealthcare star km percent of total billed charges · outpatientfrom % of charges	$21	$20	$7	34%	—	$10 – $29
17	UnitedHealthcare star plus km percent of total billed charges · outpatientfrom % of charges	$21	$20	$7	34%	—	$10 – $29
18	Aetna mm percent of total billed charges · outpatientfrom % of charges	$36	$34	$12	34%	—	$18 – $49
19	UnitedHealthcare hix percent of total billed charges · outpatientfrom % of charges	$41	$40	$14	34%	—	$21 – $57
20	Molina chip km percent of total billed charges · outpatientfrom % of charges	$44	$43	$15	34%	—	$22 – $61
21	Molina star km percent of total billed charges · outpatientfrom % of charges	$44	$43	$15	34%	—	$22 – $61
22	Molina star plus km percent of total billed charges · outpatientfrom % of charges	$44	$43	$15	34%	—	$22 – $61
23	UnitedHealthcare all payer percent of total billed charges · outpatientfrom % of charges	$44	$43	$15	34%	—	$22 – $61
24	Cigna new business percent of total billed charges · outpatientfrom % of charges	$58	$56	$19	34%	—	$29 – $79
25	Healthcare Highways ppo percent of total billed charges · outpatientfrom % of charges	$67	$65	$22	34%	—	$33 – $92

Page 1 of 2 · 30 rates

Last updated: Jan 13, 2026

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