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Maine rates for HCPCS J0295

Ampicillin Sodium Per 1.5 Gm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.22 / $28.44 / $95.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.80 / $1.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.30 / $4.30 / $4.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.68
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.22 / $22.32 / $99.45
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.59 / $3.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $2.43