go back

Maine rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.03 / $191.95 / $246.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.64 / $20.85 / $22.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.34 / $61.34 / $61.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $24.03
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.03 / $49.60 / $233.66
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.64 / $20.85 / $49.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.86 / $19.84 / $34.72