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Ohio rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.70 / $4.12 / $49.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.55 / $1.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.83 / $1.29 / $3.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $1.09
Aultcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.74 / $0.74 / $0.74
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.96
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $0.52 / $0.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $3.95
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.90 / $5.09 / $23.39
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $3.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.68 / $0.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.77