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New Hampshire rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $562.34 / $776.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.17 / $0.25 / $0.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.12 / $0.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.04 / $0.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.18