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Massachusetts 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 / $14.14 / $33.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.14 / $14.14 / $14.14
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.59 / $40.32 / $100.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.17 / $12.17 / $12.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.82 / $9.30 / $19.82
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.14 / $40.14 / $85.10
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.14 / $40.14 / $40.14