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Virginia rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $46.77 / $288.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.20
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.12 / $0.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.12 / $0.14
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.12 / $0.20
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.12 / $0.18
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.12 / $0.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.13