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Pennsylvania rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.74 / $7.83 / $173.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $2.41
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.64 / $0.75 / $1,638.34
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.50 / $0.59 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $0.55 / $0.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.05 / $14.73 / $81.91
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.64 / $0.73 / $1,573.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $7.83 / $171.60
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.55 / $1.49
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $0.55 / $0.55
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $0.73 / $0.84
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.73 / $0.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $1.15