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Vermont rates for HCPCS J0120

Injection Tetracycline Up To 250 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.14 / $14.14 / $23.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.29 / $7.29 / $7.29