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Utah rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.02 / $56.80 / $242.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.02 / $23.02 / $23.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.28 / $28.55 / $41.12
Cigna
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 / $19.84