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Idaho rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.06 / $0.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.18 / $0.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.12 / $0.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.15 / $0.17
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.14 / $0.15
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.14 / $0.15
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.17