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Arizona rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.99 / $4.80 / $67.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.60 / $2.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $1.90 / $3.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.47 / $3.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.49 / $0.77 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55