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Nebraska rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.23 / $24.98 / $43.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.23 / $19.84 / $57.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.84 / $22.46 / $22.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.52 / $21.34 / $22.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.00 / $21.00 / $21.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.43 / $19.84 / $24.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.12 / $100.00 / $157.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.23 / $17.23 / $25.85
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.67 / $24.62 / $30.62
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.21 / $26.26 / $44.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.85 / $19.84 / $29.76