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West Virginia rates for HCPCS J1205

Injection, chlorothiazide sodium, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.84 / $40.38 / $40.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $40.79
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.45 / $59.18 / $59.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.21 / $39.45 / $87.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $404.15
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.68 / $702.68 / $702.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $188.50