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Rhode Island rates for HCPCS J1205

Injection, chlorothiazide sodium, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.21 / $128.21 / $128.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $41.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.38 / $40.38 / $83.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.04 / $39.45 / $39.45