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Missouri rates for HCPCS J1120

Acetazolamid Sodium Injectio

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.12 / $47.64 / $69.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $20.85 / $47.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.04 / $21.63 / $52.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $24.80
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.28 / $55.20 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.65 / $17.23 / $19.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $24.74