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Pennsylvania rates for HCPCS J1205

Injection, chlorothiazide sodium, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.84 / $94.49 / $122.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.84 / $143.55
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.38 / $42.80 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.94 / $40.94 / $40.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.21 / $39.45 / $39.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.79 / $94.49 / $122.76
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $40.79 / $122.76
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.21 / $39.45 / $39.45
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.51 / $40.51 / $47.01
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.51 / $40.51 / $47.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $72.19