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Wisconsin rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.35 / $75.86 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.29 / $3.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.74 / $0.74 / $0.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $1.62 / $2.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.76 / $1.10
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $0.55 / $1.41
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $1.10 / $1.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.49 / $1.41 / $39.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.49 / $1.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $64.57 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.65 / $2.19
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $0.59 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.59
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $0.85 / $1.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.93