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Montana rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.61 / $40.61 / $71.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.59 / $2.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $0.68 / $2.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $0.68 / $2.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.60 / $0.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55