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Acetazolamide Injection

Wisconsin rates for HCPCS J1120

Injection, acetazolamide sodium, up to 500 mg

Rates data updated July 2026.

Facilitymedian $36 · 10th–90th $25$1070%10%10th90th$36Professionalmedian $25 · 10th–90th $25$500%20%40%90th$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
Setting
Facility
Modifier
Global
Typical Low
$25.12
Median
$48.98
Typical High
$181.97
Aetna
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$25.12
Typical High
$72.44
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$24.55
Typical High
$30.90
Cigna
Setting
Facility
Modifier
Global
Typical Low
$32.36
Median
$63.10
Typical High
$107.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$30.90
Typical High
$46.77
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$19.95
Typical High
$43.65
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$39.81
Typical High
$39.81
Medica
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$17.38
Typical High
$120.23
Medica
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$17.38
Typical High
$39.81
Molina
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$64.57
Typical High
$85.11
Network Health
Setting
Facility
Modifier
Global
Typical Low
$29.51
Median
$29.51
Typical High
$58.88
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$19.95
Typical High
$43.65
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$39.81
Typical High
$39.81
Quartz
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$30.90
Typical High
$61.66
Quartz
Setting
Facility
Modifier
Global
Typical Low
$32.36
Median
$74.13
Typical High
$112.20
Quartz
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$24.55
Typical High
$29.51
Security Health
Setting
Professional
Modifier
Global
Typical Low
$17.78
Median
$38.02
Typical High
$46.77
United
Setting
Facility
Modifier
Global
Typical Low
$24.55
Median
$24.55
Typical High
$60.26
United
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$25.70
Typical High
$38.02