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Mississippi 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
$41.42 / $47.34 / $48.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $41.42 / $53.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.04 / $191.04 / $210.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.45 / $39.45 / $131.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.86 / $39.45 / $51.29