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Pennsylvania rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.84 / $45.49 / $603.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $20.04 / $57.35
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.30 / $21.53 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.59 / $20.59 / $20.59
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
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.10 / $44.10 / $161.46
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.39 / $45.49 / $272.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.39 / $20.04 / $52.38
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.72 / $19.84 / $19.84
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.93 / $23.93 / $27.77
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.93 / $23.93 / $27.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $34.19