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Wisconsin rates for HCPCS J0120

Injection, tetracycline, up to 250 mg

Facilitymedian $13 · 10th–90th $13–$300%50%10th90th$13Professionalmedian $13 · 10th–90th $13–$160%50%90th$13$2.0$5.0$10.0$20.0$50.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.88 / $13.18 / $13.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $15.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.45 / $33.88 / $33.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.18 / $24.55 / $35.48
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.23 / $11.48 / $12.88
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.18 / $13.18 / $13.18
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.18 / $13.18 / $13.18
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $54.95 / $85.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.13 / $10.23 / $12.02