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Texas rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.86 / $39.06 / $278.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.40 / $6.07 / $12.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.43 / $1.43 / $1.43
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.49 / $0.67 / $18.59
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.49 / $0.80 / $36.40
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.61 / $1.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $0.55 / $1.60
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $1.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.71 / $0.74