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New York 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 / $19.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $13.31 / $14.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.00 / $225.00 / $347.50
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.55 / $4.55 / $7.87
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.22 / $40.19 / $40.52
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.00 / $13.00 / $13.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.17 / $12.17 / $12.17
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.17 / $12.17 / $12.17