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Alaska rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $63.70 / $252.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.60 / $1.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.46 / $1.46 / $1.46
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $1.77
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.07 / $4.13 / $6.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $4.13 / $9.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.83 / $1.11