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Missouri rates for HCPCS J1205

Injection, chlorothiazide sodium, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.21 / $68.43 / $281.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $40.79 / $103.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.84 / $43.00 / $103.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $49.31
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.85 / $160.36 / $430.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.47 / $40.38 / $46.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.53 / $39.45 / $48.25