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Montana rates for HCPCS J1205

Injection, chlorothiazide sodium, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.00 / $48.86 / $143.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$550.20 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.07 / $37.07 / $161.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.07 / $39.45 / $39.45
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.07 / $37.07 / $161.35
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $42.79 / $55.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45