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North Dakota rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.44 / $0.59 / $0.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.49 / $0.83 / $2.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.55 / $0.60