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North Dakota rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.84 / $19.84 / $31.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $22.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.53 / $21.64 / $21.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.30 / $21.61 / $21.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.43 / $19.62 / $24.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.23 / $29.70 / $47.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.23 / $17.23 / $19.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.86 / $19.84 / $26.81