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Hawaii rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $507.45 / $507.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.06
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.06 / $0.14