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Connecticut rates for HCPCS J0120

Injection Tetracycline Up To 250 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.14 / $21.24 / $46.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.14 / $14.14 / $14.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $1.00 / $202.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $50.00 / $50.00