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Michigan rates for HCPCS J0120

Injection, tetracycline, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.31 / $13.31 / $41.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.31 / $13.31 / $13.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.23 / $18.23 / $18.23
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.06 / $23.29 / $41.53
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.06 / $1.27 / $13.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00