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Iowa rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.14 / $52.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.05
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.06 / $1.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.06 / $1.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.06 / $0.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03