go back

Nebraska rates for HCPCS J1205

Injection, chlorothiazide sodium, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $63.10 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $58.88 / $338.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $53.70 / $66.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $63.10 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $58.88 / $74.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $97.72 / $426.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $40.74 / $60.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $50.12 / $50.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.36 / $57.54 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $57.54 / $87.10