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Maine 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
$38.60 / $38.60 / $41.60
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
$1.00 / $1.00 / $198.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.14 / $40.14 / $48.61
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.60 / $38.60 / $41.60
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.14 / $14.14 / $41.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.29 / $7.29 / $40.14