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Washington, DC rates for HCPCS J0295

Ampicillin Sodium Per 1.5 Gm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.23 / $5.66 / $96.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $3.02 / $5.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.31 / $1.39
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.18 / $1.18 / $1.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.39 / $2.25