go back

Montana rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $55.80 / $148.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.24 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04