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New York rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.86 / $13.80 / $52.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.11 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.43
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.07
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.04
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $0.14 / $0.14
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $50,118.72 / $75,857.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.12 / $0.17
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.05
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.05