Injection of tetracycline, up to 250 mg

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Tetracyclin injection

Payers reporting HCPCS J0120

Payer pricing summary

Low

Average

$63

Median

$32

High

$407

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +11 other terms	99	$18	$27	$19	69%	—	$11 – $144
2	Humana fee schedule · outpatient · +7 other terms	69	$13	$14	$8	55%	—	$3 – $23
3	Blue Cross Blue Shield facility · fee schedule · outpatient · +8 other terms	25	$11	$26	$28	109%	—	$0 – $112
4	UnitedHealthcare facility · case rate · outpatient · +10 other terms	19	$47	$44	$22	50%	—	$0 – $82
5	Anthem facility · case rate · outpatient · +5 other terms	15	$47	$52	$12	23%	—	$32 – $80
6	Caresource facility · case rate · outpatient · +1 other terms	15	$48	$52	$12	23%	—	$32 – $82
7	Molina facility · case rate · outpatient · +3 other terms	15	$47	$52	$12	23%	—	$33 – $80
8	Bcbs Mn fee schedule · outpatient · +5 other terms	12	$0	$0	$0	77%	—	$0 – $1
9	Cigna facility · fee schedule · outpatient · +6 other terms	12	$18	$19	$7	37%	—	$0 – $31
10	Optum facility · case rate · outpatient · +4 other terms	11	$45	$49	$11	22%	—	$40 – $73
11	Medica fee schedule · both · +3 other terms	9	$8	$8	—	—	—	$8 – $8
12	Ucare fee schedule · both · +1 other terms	9	$8	$8	$0	3%	—	$8 – $8
13	MultiPlan percent of total billed charges · outpatientfrom % of charges · +4 other terms	8	$41	$41	$3	6%	—	$39 – $44
14	Aetna Better Health fee schedule · inpatient · +2 other terms	7	$14	$14	—	—	—	$14 – $14
15	First Health facility · fee schedule · outpatient · +4 other terms	4	$42	$42	—	—	—	$42 – $42
16	Bcbs Ks fee schedule · outpatient · +1 other terms	3	$17	$17	—	—	—	$17 – $17
17	Highmark fee schedule · outpatient · +1 other terms	2	$18	$31	$36	116%	—	$0 – $98
18	Bcbs Id facility · fee schedule · outpatient	1	$9	$9	—	—	—	$9 – $9
19	Bcbs Nv fee schedule · outpatient	1	$0	$0	—	—	—	$0 – $0
20	Bcbs Vt professional · fee schedule · outpatient	1	$14	$14	—	—	—	$14 – $14
21	Healthpartners facility · fee schedule · outpatient	1	$31	$31	—	—	—	$31 – $31
22	Kaiser facility · fee schedule · outpatient	1	$310	$310	—	—	—	$310 – $310
23	Magellan fee schedule · outpatient	1	$98	$98	—	—	—	$98 – $98
24	Medicaid percent of total billed charges · bothfrom % of charges	1	$407	$407	$278	68%	—	$129 – $685
25	Oscar professional · percent of total billed charges · outpatientfrom % of charges	1	$127	$127	—	—	—	$127 – $127