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California rates for HCPCS J0120

Injection, tetracycline, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.81 / $31.12 / $36.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $13.81 / $23.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.93 / $36.20 / $41.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.11 / $34.11 / $225.00
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.00 / $35.00 / $393.93
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.81 / $19.75 / $38.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.78 / $30.78 / $33.28