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Louisiana 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 / $23.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.64 / $16.64 / $16.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.26 / $3.26 / $3.32