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Georgia rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $91.20 / $891.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.13 / $0.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.12 / $0.12
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
$0.05 / $0.52 / $0.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.08 / $0.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.14