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Indiana rates for HCPCS J1205

Injection, chlorothiazide sodium, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.84 / $95.76 / $287.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.84 / $40.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.42 / $78.90 / $118.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.53 / $39.45 / $56.01
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.45 / $39.45 / $53.26
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $49.31
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 / $109.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $52.70