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Wyoming rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.49 / $40.61 / $71.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.95 / $2.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $0.52 / $0.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55