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Virginia rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.83 / $39.72 / $255.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $20.83 / $22.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.86 / $37.40 / $56.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.72 / $18.72 / $19.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.86 / $23.81 / $49.55
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.84 / $19.84 / $30.89
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.00 / $34.00 / $34.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.85 / $24.01 / $45.26
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.85 / $24.01 / $45.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.23 / $19.84 / $24.90