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Oregon rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.92 / $120.23 / $575.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.72 / $0.85
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.13 / $6.92
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.12 / $0.15
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.05 / $0.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.11 / $0.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.04 / $79.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12