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New Jersey rates for HCPCS J0295

Ampicillin Sodium Per 1.5 Gm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.28 / $9.67 / $35.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.41
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.70 / $82.20 / $411.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.39 / $2.70 / $3.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.57 / $8,702.00 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.55 / $1.55 / $2.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.70