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Nebraska rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $144.54 / $251.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.11 / $0.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.14 / $0.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.12 / $0.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.14 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.15
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.11 / $0.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.12 / $0.13