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Maryland rates for HCPCS J0295

Ampicillin Sodium Per 1.5 Gm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.14 / $20.44 / $74.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $2.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.77
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $5.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.47
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.64 / $1.64 / $1.64