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Oklahoma rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.53 / $4.34 / $91.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.25 / $1.95 / $3.05
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 / $2.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.49 / $1.00 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55