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Oklahoma rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $42.66 / $123.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $0.81 / $1.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.11 / $0.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.12 / $0.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.04 / $75.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.12 / $0.12