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Indiana rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.92 / $95.50 / $263.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $0.18 / $0.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.23
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.06 / $0.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.12 / $0.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.13