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California rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $83.18 / $398.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.13 / $0.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.12
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.13 / $0.17
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.14 / $0.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.11 / $0.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.13 / $0.27
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.04 / $0.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.04
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.09
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.25