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Minnesota rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $22.91 / $22.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.10 / $0.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.10 / $0.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.12 / $0.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.13 / $0.14
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $0.11 / $0.14
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.11 / $0.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.06 / $0.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.12 / $0.17