Ampicillin and sulbactam injection, 3 g at St.davids Surgical Hospital

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

AMPICIL/SULBAC 3 G INJ

Austin, TX

See all payers reporting HCPCS J0295 →

Payers reporting HCPCS J0295 at St.davids Surgical Hospital

Negotiated rates from the hospital’s own file: 6 payers, 24 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 narrownetworkhix fee schedule · outpatient	$2	$2	—	—	—	$2 – $2
2	UnitedHealthcare allpayerappendix fee schedule · outpatient	$2	$2	—	—	—	$2 – $2
3	UnitedHealthcare smallgroup fee schedule · outpatient	$2	$2	—	—	—	$2 – $2
4	Blue Cross Blue Shield blueadvantage fee schedule · outpatient	$4	$4	—	—	—	$4 – $4
5	Blue Cross Blue Shield mybluehealth fee schedule · outpatient	$4	$4	—	—	—	$4 – $4
6	Blue Cross Blue Shield blueessentials fee schedule · outpatient	$7	$7	—	—	—	$7 – $7
7	Blue Cross Blue Shield blueessentialsaccess fee schedule · outpatient	$7	$7	—	—	—	$7 – $7
8	Blue Cross Blue Shield eposoa fee schedule · outpatient	$8	$8	—	—	—	$8 – $8
9	Blue Cross Blue Shield ppo fee schedule · outpatient	$8	$8	—	—	—	$8 – $8
10	Superior Healthplan chip percent of total billed charges · outpatientfrom % of charges	$18	$15	$9	61%	—	$0 – $22
11	Superior Healthplan chpfc percent of total billed charges · outpatientfrom % of charges	$18	$15	$9	61%	—	$0 – $22
12	Superior Healthplan star percent of total billed charges · outpatientfrom % of charges	$18	$15	$9	61%	—	$0 – $22
13	Superior Healthplan starplus percent of total billed charges · outpatientfrom % of charges	$18	$15	$9	61%	—	$0 – $22
14	Superior Healthplan ambetterepo percent of total billed charges · outpatientfrom % of charges	$61	$50	$30	61%	—	$0 – $76
15	Superior Healthplan ambetterhmo percent of total billed charges · outpatientfrom % of charges	$61	$50	$30	61%	—	$0 – $76
16	Superior Healthplan valuehmo percent of total billed charges · outpatientfrom % of charges	$61	$50	$30	61%	—	$0 – $76
17	UnitedHealthcare optionsppo percent of total billed charges · outpatientfrom % of charges	$90	$73	$44	61%	—	$0 – $111
18	Humana hmo percent of total billed charges · outpatientfrom % of charges	$100	$81	$49	61%	—	$0 – $124
19	Humana ppo percent of total billed charges · outpatientfrom % of charges	$100	$81	$49	61%	—	$0 – $124
20	Blue Cross Blue Shield traditional percent of total billed charges · outpatientfrom % of charges	$106	$86	$52	61%	—	$0 – $132
21	UnitedHealthcare globalbenefitplan percent of total billed charges · outpatientfrom % of charges	$162	$131	$80	61%	—	$0 – $201
22	First Health ppo percent of total billed charges · outpatientfrom % of charges	$222	$187	$115	61%	—	$1 – $308
23	MultiPlan phcsprimarynetwork percent of total billed charges · outpatientfrom % of charges	$270	$219	$133	61%	—	$1 – $335
24	MultiPlan complementarynetwork percent of total billed charges · outpatientfrom % of charges	$306	$248	$151	61%	—	$1 – $380