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Louisiana rates for HCPCS J1120

Acetazolamid Sodium Injectio

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.39 / $20.44 / $125.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.39 / $20.04 / $22.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $18.30 / $31.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.97 / $20.97 / $21.39
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.72 / $18.72 / $19.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $41.45