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Arizona rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.23 / $54.30 / $152.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.95 / $21.83 / $57.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.60 / $65.55 / $107.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.47 / $16.68 / $126.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.23 / $27.10 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.23 / $17.23 / $17.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84