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Tennessee rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $4.16 / $54.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.38 / $3.38 / $3.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $2.38