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Michigan rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.46 / $22.39 / $54.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.13 / $0.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $6.46 / $42.66
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.12 / $0.16
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.13