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Arizona rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.46 / $114.82 / $524.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.11 / $0.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.22 / $0.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.04 / $75.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.12 / $0.12