go back

Missouri rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $38.90 / $91.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $25.70 / $47.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $25.70 / $67.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $24.55 / $25.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.99 / $25.70 / $25.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $25.70 / $26.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.20 / $54.95 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.45 / $17.38 / $20.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $25.70 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $25.70 / $31.62