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Pennsylvania rates for HCPCS J0295

Ampicillin Sodium Per 1.5 Gm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.49 / $12.11 / $174.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.41 / $6.92
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.62 / $1.90 / $556.49
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.28 / $1.51 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $1.44 / $1.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.39 / $1.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.20 / $17.48 / $56.52
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.62 / $1.85 / $534.29
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.54 / $18.26 / $99.22
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.52 / $4.53
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,003.93 / $1,349.03 / $1,669.48
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.39 / $1.39
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $2.65
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $2.27 / $2.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $2.94