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Idaho 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
$40.38 / $40.38 / $46.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $43.39 / $49.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.21 / $39.45 / $39.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.28 / $49.31 / $70.51
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $49.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.47 / $32.47 / $32.47
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.07 / $150.07 / $184.18
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.34 / $47.34 / $49.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $63.12