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Michigan rates for HCPCS J1205

Injection, chlorothiazide sodium, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.63 / $41.59 / $129.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $40.63 / $48.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.76 / $87.84 / $166.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.57 / $15.34 / $15.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $554.57
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.45 / $72.78 / $124.75
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $40.63 / $48.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $41.86