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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

Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.

HospitalMedicaid managed care rates (lowest – highest)Cash priceList price (before discounts)
BHC Fairfax HospitalKirkland—$38.00 – $58.00$38.00 – $58.00
Capital Medical CenterOlympiaFile dated 2026-08-27—$32.56 – $62.89$81.40 – $157
Cascade Valley HospitalArlington$17.66 – $49.981 plan$14.13 – $39.98$17.66 – $49.98
Deaconess Medical CenterSpokaneFile dated 2026-08-27—$51.34 – $102$128 – $256
EvergreenHealth Medical CenterKirkland—$37.60 – $90.40$47.00 – $113
EvergreenHealth MonroeMonroe—$43.20 – $78.40$54.00 – $98.00
Harborview Medical CenterSeattleFile dated 2026-04-01———
Highline Medical CenterBurienFile dated 2026-02-28—$34.68 – $560$114 – $1,835
Island HospitalAnacortes———
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01—$34.61 – $53.86$49.44 – $76.94
Legacy Salmon Creek Medical CenterVancouverFile dated 2026-04-01———
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27—$37.60 – $74.26$94.00 – $186
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27—$32.56 – $64.94$81.40 – $162
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27—$32.56 – $62.90$81.40 – $157
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27—$32.56 – $64.94$81.40 – $162
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27—$41.31 – $102$103 – $256
Olympic Medical CenterPort AngelesFile dated 2026-06-24—$44.85 – $94.58$56.06 – $118
Overlake Hospital Medical Center & ClinicsBellevueFile dated 2026-04-01—$9.75 – $19.50$19.50 – $39.00
PeaceHealth Peace Island Medical CenterFriday Harbor—$115 – $164$178 – $252
PeaceHealth Southwest Medical CenteVancouver—$115 – $164$178 – $252
PeaceHealth St John Medical CenterLongview—$115 – $164$178 – $252
PeaceHealth St Joseph Medical CenterBellingham—$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—$70.66 – $146$101 – $209
Providence Centralia HospitalCentraliaFile dated 2026-04-01—$45.82 – $47.65$88.11 – $91.64
Providence Holy Family HospitalSpokaneFile dated 2026-04-01—$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—$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—$30.00 – $164$42.86 – $234
Providence St Peter HospitalOlympiaFile dated 2026-04-01—$43.91 – $113$84.44 – $217
Seattle Children's HospitalSeattle$20.37 – $33.5312 plans$79.25 – $103$79.25 – $103
Skagit Valley HospitalMount Vernon—$14.13 – $39.98$17.66 – $49.98
St Anthony HospitalGig HarborFile dated 2026-02-28—$34.54 – $558$114 – $1,835
St Clare HospitalLakewoodFile dated 2026-02-28—$32.73 – $529$114 – $1,835
St Elizabeth HospitalEnumclawFile dated 2026-02-28$19.31 – $3805 plans$40.13 – $649$114 – $1,835
St Francis Community HospitalFederal WayFile dated 2026-02-28—$35.64 – $576$114 – $1,835
St Joseph Medical CenterTacomaFile dated 2026-02-28—$37.61 – $608$114 – $1,835
St Michael Medical CenterSilverdaleFile dated 2026-02-28—$50.12 – $810$114 – $1,835
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01—$36.04 – $55.69$75.08 – $116
Swedish IssaquahIssaquahFile dated 2026-04-01—$36.04 – $55.69$75.08 – $116
Swedish Medical CenterSeattleFile dated 2026-04-01—$36.04 – $55.69$75.08 – $116
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01—$36.04$75.08
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27—$5.68 – $64.94$14.19 – $162
Three Rivers HospitalBrewster$37.93 – $64.561 plan$54.18 – $92.22$54.18 – $92.22
University of Washington Medical CtrSeattleFile dated 2026-04-01———
Virginia Mason Medical CenterSeattle—$4.29 – $9.14$8.42 – $17.93
WhidbeyHealth Medical CenterCoupeville—$54.00$54.00
Yakima Valley MemorialYakimaFile dated 2026-08-27—$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.