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Georgia rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $72.00 / $433.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.08
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
$0.05 / $0.52 / $0.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.07