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Massachusetts rates for HCPCS J1205

Injection, chlorothiazide sodium, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.45 / $39.45 / $78.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $41.02 / $48.46
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.16 / $86.68 / $219.40
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $160.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.33 / $50.34 / $107.30
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.95 / $78.90 / $8,090.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $83.63
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.40 / $219.40 / $430.71
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $160.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $160.22