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Alaska rates for HCPCS J1120

Acetazolamid Sodium Injectio

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.22 / $86.81 / $189.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.39 / $36.90 / $57.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.78 / $52.78 / $52.78
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $63.88
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.61 / $66.70 / $104.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.27 / $67.20 / $158.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $21.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $29.76 / $40.02