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New York rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.23 / $5.13 / $20.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.82 / $5.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.56 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $5.25
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.62 / $0.79 / $2.19
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.71 / $1.17
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.58
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.56
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $0.89 / $2.63
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.63 / $50,118.72 / $75,857.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $1.05
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.66
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.56 / $2.34