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Vermont rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.88 / $3.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.62 / $0.62 / $0.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.62 / $0.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $1.00