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Vermont rates for HCPCS J0295

Ampicillin Sodium Per 1.5 Gm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.96 / $12.96 / $17.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $2.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.58 / $1.58 / $1.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.78 / $2.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $1.78 / $2.97
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.39 / $1.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.39 / $5.01