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Indiana 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
$13.31 / $13.31 / $59.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.31 / $13.31 / $13.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.97 / $1.00 / $1.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.32