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Pennsylvania rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Facilitymedian $63 · 10th–90th $26$2690%20%10th90th$63Professionalmedian $25 · 10th–90th $25$390%50%90th$25$10.0$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$25.70 / $66.07 / $269.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.12 / $25.12 / $38.90
AmeriHealth
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$27.54 / $27.54 / $38.90
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$23.44 / $27.54 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.30 / $26.30 / $26.30
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$24.55 / $85.11 / $91.20
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $24.55 / $24.55
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$24.55 / $24.55 / $24.55
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $42.66 / $42.66
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $173.78 / $199.53
Independence Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$27.54 / $27.54 / $32.36
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$25.12 / $37.15 / $67.61
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.12 / $25.12 / $28.18
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.91 / $22.91 / $23.99
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.91 / $22.91 / $23.99
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $42.66