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Arizona rates for HCPCS J0295

Ampicillin Sodium Per 1.5 Gm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.78 / $12.80 / $92.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $1.80 / $6.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $5.03 / $8.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $1.44 / $8.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $6.98 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.49 / $1.49 / $1.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39