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Maryland rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.23 / $45.00 / $143.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.09 / $19.84 / $23.09
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.23 / $17.23 / $19.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $25.27
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $44.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $28.62
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.62 / $21.62 / $21.62