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Idaho rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.23 / $17.23 / $30.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.23 / $21.63 / $24.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.72 / $19.84 / $19.84
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
$20.14 / $24.80 / $35.46
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $24.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.81 / $23.81 / $24.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $31.74