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Indiana rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.39 / $56.76 / $119.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $20.04 / $20.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.83 / $39.68 / $59.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.86 / $19.84 / $28.17
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.84 / $19.84 / $29.76
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $24.80
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 / $65.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $33.72