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Pennsylvania rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.08 / $192.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.13
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.04 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.54 / $4.45
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.09 / $78.40
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.09
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.04
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.06
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.07