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South Carolina rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $97.72 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $25.70 / $41.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $30.20 / $34.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $27.54 / $33.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.99 / $25.70 / $25.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $25.70 / $25.70
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.92 / $31.62 / $67.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $25.70 / $26.30