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West Virginia rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.78 / $30.62 / $91.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $0.83 / $0.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $0.55 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $5.24
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.76 / $8.36 / $30.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $3.96