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North Carolina rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $24.55 / $88.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $0.10 / $0.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.14
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.15
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.10
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00