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Washington rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $1.20 / $245.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.60 / $1.04
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $1.08 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.77 / $2.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $0.52 / $1.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.67
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.49 / $0.63 / $1.47
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.08 / $2.45 / $2.45
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $0.82 / $2.95
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55