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Michigan rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $1.95 / $20.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.56 / $0.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.65 / $1.25 / $2.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $3.79
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $1.39 / $25.13
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.55 / $0.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.63 / $0.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.57