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Vermont rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $22.04 / $29.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.46 / $22.46 / $22.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.72 / $21.58 / $35.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.72 / $21.58 / $35.96
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.84 / $19.84 / $19.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.52 / $19.84 / $42.12