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Wisconsin rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Facilitymedian $38 · 10th–90th $26–$850%20%10th90th$38Professionalmedian $25 · 10th–90th $25–$470%20%40%10th90th$25$20.0$50.0$100.0

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 / $38.02 / $181.97
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.12 / $25.12 / $43.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $24.55 / $30.90
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $57.54 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $32.36 / $46.77
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.88 / $19.95 / $43.65
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $39.81 / $39.81
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.88 / $17.38 / $120.23
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17.38 / $17.38 / $39.81
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $64.57 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$29.51 / $29.51 / $58.88
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $28.18 / $61.66
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $25.70 / $25.70
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17.78 / $33.11 / $40.74
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
$25.70 / $25.70 / $38.02