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Missouri rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $45.71 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.20 / $0.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.12 / $0.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.12 / $0.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.17 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.12 / $0.13