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Massachusetts rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $5.72 / $50.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.56 / $0.59
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.15 / $1.68 / $75.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $3.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $0.70 / $1.50
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.65 / $83.43 / $8,090.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $1.17
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $5.91 / $44.70
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $3.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $3.37