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California rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.09 / $206.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.10
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $0.12 / $0.20
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.09
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.06
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.09
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
$0.03 / $0.04 / $0.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.23 / $0.23 / $0.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.10