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Kentucky rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $60.26 / $263.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.14 / $0.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.12 / $0.12
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.06
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $85.11 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.43 / $0.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12