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Alaska rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $43.55 / $256.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.07 / $0.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $0.10 / $0.10
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.13
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $0.20 / $0.31
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.24 / $0.56
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.06 / $0.08