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Wisconsin rates for HCPCS J1205

Injection, chlorothiazide sodium, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.63 / $78.73 / $92.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $40.63 / $143.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.31 / $49.31 / $49.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $50.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.01 / $54.01 / $63.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.45 / $96.86 / $138.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.08 / $189.26 / $215.06
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.45 / $40.38 / $86.97
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.57 / $78.90 / $104.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.38 / $40.38 / $89.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.38 / $40.38 / $78.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.47 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.45 / $40.38 / $86.97
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.57 / $78.90 / $104.48
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.44 / $66.51 / $187.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$430.71 / $430.71 / $430.71
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.39 / $55.39 / $115.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $63.12