go back

Oklahoma rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $27.54 / $46.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $25.70 / $29.51
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.30 / $19.05 / $31.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.99 / $23.99 / $25.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $25.70 / $29.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.38 / $20.42 / $75.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $17.38 / $19.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $25.70 / $25.70