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Illinois rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $66.07 / $218.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.81 / $1.41 / $6.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.28 / $100.00
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.07 / $0.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12