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South Carolina 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 / $171.42 / $689.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.42 / $65.42 / $76.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.10 / $360.68 / $917.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.50 / $38.68 / $53.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.21 / $37.21 / $39.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.98 / $45.56 / $196.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45