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Illinois rates for HCPCS J1205

Injection, chlorothiazide sodium, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.45 / $69.04 / $135.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $40.38 / $48.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.83 / $331.54 / $1,495.00
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
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.56 / $59.18 / $295.52
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $51.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $71.01