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Wyoming rates for HCPCS J1205

Injection, chlorothiazide sodium, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.38 / $40.38 / $40.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $40.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.62 / $98.38 / $98.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.21 / $37.21 / $37.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $55.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.45 / $39.45 / $39.45