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Kansas rates for HCPCS J0295

Ampicillin Sodium Per 1.5 Gm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.94 / $42.95 / $89.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.50 / $5.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.98 / $2.33 / $6.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.90 / $1.90 / $1.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.31 / $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
$1.75 / $2.27 / $6.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.49 / $1.49 / $2.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $2.36