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Indiana rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $25.30 / $199.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.57 / $1.10 / $1.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.46 / $0.55 / $0.78
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.82
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.69
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 / $2.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $1.10