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New Hampshire rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.23 / $19.82 / $71.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.30 / $19.84 / $19.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.72 / $29.76 / $81.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.23 / $19.84 / $19.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.72 / $19.84 / $19.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.93 / $33.03 / $61.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $22.60
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.99 / $48.78 / $71.70