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South Carolina rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.55 / $44.67 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.82 / $9.12 / $9.12
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $54.95 / $54.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $20.89 / $52.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.65 / $0.71 / $2.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.59 / $0.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.59
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.62 / $2.00 / $2.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.65