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Maine 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
$91.52 / $91.52 / $98.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.02 / $48.86 / $48.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.98 / $121.98 / $121.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $47.77
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.52 / $91.52 / $98.63
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.02 / $48.86 / $98.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $145.63