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Montana rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Facilitymedian $31 · 10th–90th $26–$1070%20%40%10th90th$31Professionalmedian $28 · 10th–90th $25–$780%50%10th90th$28$20.0$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.12 / $26.92 / $70.79
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $46,773.51 / $91,201.08
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21.88 / $21.88 / $54.95
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $24.55 / $24.55
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$27.54 / $28.18 / $81.28
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$27.54 / $28.18 / $81.28
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21.88 / $21.88 / $54.95
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $34.67 / $85.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $25.70