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Virginia rates for HCPCS J1205

Injection, chlorothiazide sodium, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.89 / $61.80 / $92.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $41.42 / $41.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.26 / $99.30 / $149.85
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.53 / $47.34 / $188.50
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.45 / $39.45 / $185.33
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.00 / $243.00 / $243.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.47 / $47.73 / $93.46
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.47 / $47.73 / $93.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.81 / $39.45 / $49.51