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Minnesota 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 / $16.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.31 / $13.81 / $16.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.26 / $0.46 / $1.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.17 / $0.21 / $0.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.73 / $32.25 / $39.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.23 / $11.88 / $12.86
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.16 / $29.43 / $36.94
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.13 / $10.13 / $13.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.49 / $22.49 / $28.12