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Kansas rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $66.07 / $331.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.05 / $0.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.12 / $0.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.12 / $0.13