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Washington rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Facilitymedian $51 · 10th–90th $26$1740%10%20%10th90th$51Professionalmedian $26 · 10th–90th $25$310%50%10th90th$26$20.0$50.0$100.0$200.0

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
$26.30 / $51.29 / $251.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.12 / $25.70 / $30.90
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$24.55 / $24.55 / $24.55
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $24.55 / $24.55
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $107.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $24.55 / $30.20
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.95 / $21.88 / $38.90
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$25.70 / $39.81 / $39.81
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.62 / $25.70 / $25.70
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$24.55 / $24.55 / $24.55
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $24.55 / $24.55
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.05 / $19.05 / $44.67
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.05 / $25.70 / $25.70
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $31.62 / $33.11