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Oregon rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.08 / $200.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $3.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.08 / $0.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.71 / $0.86
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.06 / $0.15
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.05
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.05 / $0.12
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.08 / $0.12
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.07
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04