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New Mexico rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $54.95 / $741.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,234.13 / $69,183.10 / $81,283.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
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 / $0.12
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.04 / $0.47
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.12 / $0.12