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Washington rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.17 / $196.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.06
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.08 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.05
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.04 / $0.12
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $0.12 / $0.12
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.08 / $0.14
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04