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Oregon rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.23 / $32.64 / $39.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.39 / $20.04 / $57.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.72 / $30.59 / $38.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $21.53
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.89 / $37.63 / $57.01
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.84 / $28.37 / $62.10
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $21.80 / $25.79
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.23 / $22.46 / $42.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.84 / $32.90 / $62.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.53 / $27.03 / $34.52
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $22.82