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New York rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.23 / $28.60 / $72.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $23.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $49.78
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.48 / $23.48 / $24.65
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.48 / $23.48 / $23.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.72 / $18.72 / $36.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.72 / $28.08 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.53 / $21.53 / $50.02
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.84 / $19.84 / $20.59
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $20.59
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.08 / $36.50 / $58.02
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.72 / $18.72 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $30.04 / $40.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $43.80
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.59 / $20.59 / $20.59
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $20.59 / $32.13