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Hawaii rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $512.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.14 / $0.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.12 / $0.18