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Connecticut rates for HCPCS J1205

Injection Chlorothiazide Sodium Per 500 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.02 / $62.73 / $110.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.02 / $41.02 / $41.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.31 / $69.98 / $144.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
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
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.93 / $42.80 / $49.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.51 / $39.45 / $173.42