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New Hampshire rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.04 / $559.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.06 / $0.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.07 / $0.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.48 / $0.76