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Tetracycline Injection

Pennsylvania rates for HCPCS J0120

Injection, tetracycline, up to 250 mg

Rates data updated October 2026.

How much does Tetracycline Injection cost?

$14.13per 250 mg

Typical negotiated rate. In Pennsylvania, October 2026.

Insurers have agreed to pay about $14.13 for each 250 mg of this drug. The price depends on where it is billed: about $14.13 from a physician practice, and about $10.47 from a hospital or other facility.

Work out the cost of a dose

This drug is priced per 250 mg. Enter the amount given to see what insurers have agreed to pay for it.

mg
In a doctor's office or clinic
$14.13
At a hospital outpatient department
$10.47

The same drug, in the same amount, costs 26% less at a hospital than at a doctor's office.

Drug cost only. Giving the drug, the visit itself and any monitoring are billed on their own codes. We do not publish dosing guidance: use the amount from your own prescription or treatment plan.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 3 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$14.13$14.13 to $14.13
FacilityA hospital or hospital-owned outpatient department$10.47$10.47 to $14.13

How much rates vary

Facilitymedian $10 · 10th to 90th $10 to $21Professionalmedian $14 · 10th to 90th $14 to $14
$10$20facility $10professional $14

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$14.13
Median
$14.13
Typical High
$22.39
Aetna
Setting
Professional
Modifier
None
Typical Low
$14.13
Median
$14.13
Typical High
$14.13
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$7.08
Median
$7.08
Typical High
$7.08
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$2.82
Median
$2.82
Typical High
$2.82
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$2.14
Median
$2.14
Typical High
$2.14
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$1.41
Median
$1.41
Typical High
$1.41
Capital Blue Cross
Setting
Facility
Modifier
None
Typical Low
$9.12
Median
$10.47
Typical High
$12.30
Capital Blue Cross
Setting
Professional
Modifier
None
Typical Low
$10.47
Median
$10.47
Typical High
$10.47
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$14.13
Median
$21.38
Typical High
$22.39
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$14.13
Median
$14.13
Typical High
$14.13
Martin's Point
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$7.08
Median
$7.08
Typical High
$7.08
Martin's Point
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$2.82
Median
$2.82
Typical High
$2.82
Martin's Point
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$2.14
Median
$2.14
Typical High
$2.14
Martin's Point
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$1.41
Median
$1.41
Typical High
$1.41

Where Pennsylvania sits

The same service costs 1412.5 times more in Wyoming than in Missouri. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Pennsylvania· 19th of 51

$14.13

WY $85.11MO $0.06

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.