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Montana rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.85 / $21.63 / $57.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.36 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.76 / $21.76 / $54.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $21.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.76 / $21.76 / $54.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $21.53 / $28.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84