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West Virginia 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
$14.14 / $14.14 / $14.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.81 / $14.14 / $14.14
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44,999.55 / $44,999.55 / $69,999.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.15 / $13.15 / $13.15