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Massachusetts rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $11.13 / $60.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.10 / $100.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.08 / $0.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $3,472.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.08
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.81 / $10.56 / $781.44
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.11