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Pennsylvania rates for HCPCS J0120

Injection, tetracycline, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.14 / $22.62 / $35.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.14 / $14.14 / $14.14
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.89 / $10.46 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.46 / $10.46 / $10.46
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.14 / $21.78 / $35.07
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.64 / $14.14 / $28.14