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Oregon 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 / $33.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.81 / $13.81 / $16.64
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.81 / $19.75 / $29.69
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.81 / $19.75 / $2,400,000.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.11 / $477.11 / $477.11