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Michigan rates for HCPCS J0295

Ampicillin Sodium Per 1.5 Gm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.26 / $17.07 / $62.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.43 / $1.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.78 / $3.16 / $5.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.44 / $0.44
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.91 / $1.91 / $1.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $2.95
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.49 / $11.61 / $62.20
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.45 / $1.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.59 / $1.71 / $1.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.47