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Michigan rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.73 / $31.05 / $63.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.73 / $20.44 / $22.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.52 / $44.17 / $83.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.44 / $13.09 / $13.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.84 / $19.84 / $37.03
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.84 / $34.46 / $59.65
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.73 / $19.84 / $23.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.81 / $21.91 / $22.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $21.05