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Massachusetts rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.84 / $27.58 / $47.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $20.64 / $20.68
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.68 / $60.75 / $108.87
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $42.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.29 / $25.32 / $53.96
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.61 / $53.00 / $8,090.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $42.06
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $42.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $42.12