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Louisiana rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.50 / $0.98 / $146.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.55 / $0.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.99 / $2.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.67
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $1.14