Acetazolamide sodium injection 500 mg

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

ACETAZOLAMIDE SODIUM 500 MG INJ SOLR [114]

Payers reporting HCPCS J1120

Payer pricing summary

Low

Average

$133

Median

$99

High

$815

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +24 other terms	290	$41	$100	$219	218%	18–180	$0 – $2.0k
2	Blue Cross Blue Shield fee schedule · outpatient · +28 other terms	326	$51	$69	$100	145%	13–130	$0 – $1.2k
3	Cigna fee schedule · outpatient · +22 other terms	416	$33	$68	$106	156%	11–110	$0 – $1.2k
4	UnitedHealthcare fee schedule · outpatient · +29 other terms	513	$42	$60	$271	449%	4–40	$0 – $11.3k
5	Bcbs Nd other · outpatient · +1 other terms	1	$42	$42	—	—	4–40	$42 – $42
6	Wellmark fee schedule · outpatient · +13 other terms	26	$19	$20	$3	13%	3–30	$17 – $26
7	Humana fee schedule · outpatient · +21 other terms	187	$26	$77	$97	126%	—	$0 – $712
8	Anthem fee schedule · outpatient · +20 other terms	130	$31	$70	$153	218%	—	$16 – $1.2k
9	MultiPlan fee schedule · outpatient · +17 other terms	88	$139	$166	$138	83%	—	$0 – $712
10	Molina fee schedule · outpatient · +20 other terms	59	$42	$42	$69	163%	—	$1 – $867
11	Caresource fee schedule · outpatient · +15 other terms	58	$28	$35	$48	139%	—	$0 – $412
12	Highmark facility · fee schedule · outpatient · +15 other terms	56	$40	$93	$92	99%	—	$19 – $428
13	Kaiser fee schedule · both · +15 other terms	48	$21	$21	$6	29%	—	$17 – $57
14	Medica fee schedule · outpatient · +15 other terms	48	$57	$62	$27	44%	—	$1 – $183
15	Medcost percent of total billed charges · bothfrom % of charges · +5 other terms	42	$238	$231	$82	35%	—	$2 – $1.1k
16	First Health fee schedule · outpatient · +15 other terms	35	$119	$113	$56	50%	—	$6 – $339
17	Healthcare Highways percent of total billed charges · outpatientfrom % of charges · +3 other terms	30	$187	$187	$130	69%	—	$10 – $550
18	Tricare facility · fee schedule · outpatient · +14 other terms	30	$79	$128	$82	64%	—	$13 – $293
19	Medicaid facility · fee schedule · outpatient · +11 other terms	29	$25	$37	$37	100%	—	$12 – $187
20	Amerihealth Caritas facility · fee schedule · outpatient · +12 other terms	27	$20	$23	$8	36%	—	$20 – $46
21	Excellus facility · fee schedule · both · +8 other terms	27	$19	$36	$29	81%	—	$17 – $128
22	Oscar facility · fee schedule · outpatient · +11 other terms	27	$21	$24	$3	12%	—	$21 – $31
23	Regence facility · fee schedule · both · +13 other terms	27	$26	$41	$34	83%	—	$17 – $187
24	WellCare fee schedule · outpatient · +13 other terms	27	$25	$422	$564	134%	—	$0 – $1.2k
25	Baylor Scott White Health Plan facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms	26	$122	$109	$17	16%	—	$85 – $132

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