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Louisiana 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
$39.84 / $42.40 / $89.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.84 / $48.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.72 / $35.72 / $53.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.72 / $35.72 / $36.44
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.21 / $37.21 / $39.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $67.26