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Ohio rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.89 / $37.15 / $56.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.26 / $0.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.13 / $0.21
Aultcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.11 / $0.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.20
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.12 / $0.32
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.16
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.03 / $0.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.13