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Idaho 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
$16.64 / $16.64 / $16.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.31 / $14.14 / $16.64
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.14 / $15.17 / $20.46
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.00 / $78.00 / $78.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.77 / $107.77 / $132.26