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Vermont rates for HCPCS J1205

Injection Chlorothiazide Sodium Per 500 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $69.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.66 / $44.66 / $44.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.77 / $37.21 / $61.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.77 / $37.21 / $61.29
MVP Health Care
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 / $160.22