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Massachusetts rates for HCPCS J0295

Ampicillin Sodium Per 1.5 Gm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.59 / $26.39 / $355.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.45 / $3.47
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.58 / $4.26 / $75.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $5.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.49 / $1.77 / $3.78
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.65 / $83.43 / $8,090.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $2.95
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.78 / $9.69 / $46.77
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $5.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $5.01