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North Carolina rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.33 / $51.29 / $223.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $50.12 / $50.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $0.11 / $0.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.06 / $0.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.14
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.04 / $0.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.12 / $0.12
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00