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Illinois rates for HCPCS J0295

Ampicillin Sodium Per 1.5 Gm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.37 / $40.36 / $99.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.45 / $1.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.00 / $14.93 / $42.09
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
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $2.81 / $48.82
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.81 / $1.81 / $1.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $2.50