go back

Massachusetts rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.89 / $15.49 / $85.11
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.07 / $0.07
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.11 / $0.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.24
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.16 / $2,951.21 / $8,511.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.04
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.81 / $7.41 / $17.38
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.07 / $0.07
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.11 / $0.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.07 / $0.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.12 / $0.17