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Virginia rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $40.54 / $109.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.07 / $0.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.04
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
$0.03 / $0.05 / $0.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.20
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.16
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.05 / $0.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.05