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Texas rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $25.19 / $133.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.27 / $0.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.12 / $0.12
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.33 / $36.68
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.53
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.09 / $0.59
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.06
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.07 / $0.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.05 / $0.05