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Every billing code / Treatments and drugs / Injections and Infusions (nononcologic)

HCPCS J0295

Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm

Current code50 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.

HospitalCommercial insurance rates (lowest – highest)Cash priceList price (before discounts)
BHC Fairfax HospitalKirkland$22.04 – $40.606 plans$38.00 – $58.00$38.00 – $58.00
Capital Medical CenterOlympiaFile dated 2026-08-27$59.42 – $1342 plans$32.56 – $62.89$81.40 – $157
Cascade Valley HospitalArlington$1.50 – $5368 plans$14.13 – $39.98$17.66 – $49.98
Deaconess Medical CenterSpokaneFile dated 2026-08-27$47.67 – $1875 plans$51.34 – $102$128 – $256
EvergreenHealth Medical CenterKirkland$2.28 – $1057 plans$37.60 – $90.40$47.00 – $113
EvergreenHealth MonroeMonroe$34.02 – $91.1412 plans$43.20 – $78.40$54.00 – $98.00
Harborview Medical CenterSeattleFile dated 2026-04-01$2.221 plan——
Highline Medical CenterBurienFile dated 2026-02-28$48.83 – $1,6525 plans$34.68 – $560$114 – $1,835
Island HospitalAnacortes$1.332 plans——
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01$2.04 – $6.234 plans$34.61 – $53.86$49.44 – $76.94
Legacy Salmon Creek Medical CenterVancouverFile dated 2026-04-01$2.19 – $3.534 plans——
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27$60.71 – $1516 plans$37.60 – $74.26$94.00 – $186
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27$59.42 – $1192 plans$32.56 – $64.94$81.40 – $162
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27$59.42 – $1152 plans$32.56 – $62.90$81.40 – $157
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27$59.42 – $1192 plans$32.56 – $64.94$81.40 – $162
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27$38.36 – $1845 plans$41.31 – $102$103 – $256
Olympic Medical CenterPort AngelesFile dated 2026-06-24$31.33 – $1186 plans$44.85 – $94.58$56.06 – $118
Overlake Hospital Medical Center & ClinicsBellevueFile dated 2026-04-01$3.05 – $3.253 plans$9.75 – $19.50$19.50 – $39.00
PeaceHealth Peace Island Medical CenterFriday Harbor—$115 – $164$178 – $252
PeaceHealth Southwest Medical CenteVancouver$2.061 plan$115 – $164$178 – $252
PeaceHealth St John Medical CenterLongview$2.311 plan$115 – $164$178 – $252
PeaceHealth St Joseph Medical CenterBellingham$2.301 plan$115 – $164$178 – $252
PeaceHealth United General Medical CenterSedro Woolley—$115 – $164$178 – $252
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01$2.08 – $3.623 plans$70.66 – $146$101 – $209
Providence Centralia HospitalCentraliaFile dated 2026-04-01$4.56 – $10.064 plans$45.82 – $47.65$88.11 – $91.64
Providence Holy Family HospitalSpokaneFile dated 2026-04-01$2.08 – $3.623 plans$70.66 – $146$101 – $209
Providence Mount Carmel HospitalColvilleFile dated 2026-04-01—$70.66 – $146$101 – $209
Providence Regional Medical Center EverettEverettFile dated 2026-04-01$2.08 – $3.624 plans$39.82 – $115$76.57 – $222
Providence St Joseph HospitalChewelahFile dated 2026-04-01—$70.66 – $146$101 – $209
Providence St Mary Medical CenterWalla WallaFile dated 2026-04-01$3.62 – $12.002 plans$30.00 – $164$42.86 – $234
Providence St Peter HospitalOlympiaFile dated 2026-04-01$2.90 – $3.762 plans$43.91 – $113$84.44 – $217
Seattle Children's HospitalSeattle$42.80 – $99.0298 plans$79.25 – $103$79.25 – $103
Skagit Valley HospitalMount Vernon$2.55 – $47.487 plans$14.13 – $39.98$17.66 – $49.98
St Anthony HospitalGig HarborFile dated 2026-02-28$56.78 – $1,3763 plans$34.54 – $558$114 – $1,835
St Clare HospitalLakewoodFile dated 2026-02-28$56.78 – $1,3763 plans$32.73 – $529$114 – $1,835
St Elizabeth HospitalEnumclawFile dated 2026-02-28$2.57 – $1,6528 plans$40.13 – $649$114 – $1,835
St Francis Community HospitalFederal WayFile dated 2026-02-28$56.78 – $1,3763 plans$35.64 – $576$114 – $1,835
St Joseph Medical CenterTacomaFile dated 2026-02-28$56.78 – $1,3763 plans$37.61 – $608$114 – $1,835
St Michael Medical CenterSilverdaleFile dated 2026-02-28$3.88 – $1,65210 plans$50.12 – $810$114 – $1,835
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01$2.08 – $2.994 plans$36.04 – $55.69$75.08 – $116
Swedish IssaquahIssaquahFile dated 2026-04-01$2.08 – $2.993 plans$36.04 – $55.69$75.08 – $116
Swedish Medical CenterSeattleFile dated 2026-04-01$2.08 – $2.902 plans$36.04 – $55.69$75.08 – $116
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01$2.08 – $2.902 plans$36.04$75.08
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27$10.36 – $1192 plans$5.68 – $64.94$14.19 – $162
Three Rivers HospitalBrewster—$54.18 – $92.22$54.18 – $92.22
University of Washington Medical CtrSeattleFile dated 2026-04-01$2.221 plan——
Virginia Mason Medical CenterSeattle$4.92 – $14.349 plans$4.29 – $9.14$8.42 – $17.93
WhidbeyHealth Medical CenterCoupeville—$54.00$54.00
Yakima Valley MemorialYakimaFile dated 2026-08-27$3.77 – $1327 plans$9.40 – $61.72$23.48 – $154

Lowest and highest amounts each hospital lists for this code as an outpatient, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

CMS publishes no national amount for this code.