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Ohio rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.09 / $36.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.09 / $0.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.06
Aultcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.12
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.22
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $0.32 / $1.01
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.05