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Arizona rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.12 / $612.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.14 / $0.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.03 / $0.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.04 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04