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California rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.69 / $25.20 / $304.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $2.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.44 / $0.57 / $0.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.55 / $3.85
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $2.50 / $4.25
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.57 / $0.57 / $1.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $0.52 / $0.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.66 / $1.47
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $0.55 / $0.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $1.19
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.64 / $1.64 / $1.64
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.44 / $0.60 / $0.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $1.37