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Washington rates for HCPCS J1205

Injection, chlorothiazide sodium, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.39 / $83.99 / $150.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $43.39 / $88.24
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.45 / $71.30 / $430.71
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $65.09 / $98.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.21 / $37.21 / $64.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $48.38
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.44 / $49.31 / $118.35
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.30 / $81.66 / $81.66
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.32 / $65.59 / $98.38
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.45 / $39.45 / $194.95
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45