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Arizona rates for HCPCS J1205

Injection, chlorothiazide sodium, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.21 / $78.90 / $118.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.39 / $48.86 / $143.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.29 / $126.20 / $206.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.87 / $39.09 / $250.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.38 / $63.52 / $430.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.38 / $40.38 / $40.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45