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Michigan rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $7.04 / $43.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.09 / $0.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.42
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.08 / $42.33
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.05