go back

Utah 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
$13.81 / $13.81 / $13.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.81 / $13.81 / $13.81