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New Jersey rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.25 / $20.42 / $79.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $10,471.29 / $25,118.86
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.06 / $0.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.12 / $0.13