go back

Utah 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
$45.76 / $45.76 / $46.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.76 / $45.76 / $45.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.36 / $79.86 / $91.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.47 / $39.45 / $39.45