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Maine rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.28 / $24.67 / $91.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.56 / $0.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.70 / $1.70 / $1.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.67
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.28 / $8.27 / $82.02
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.59 / $1.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $2.39