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Wisconsin rates for HCPCS J0133

Acyclovir Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.06 / $124.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.05
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $0.09 / $0.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.10 / $0.11
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.71
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.08 / $0.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.03 / $2.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.71
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.08 / $0.26
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.06 / $1.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.04
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.04 / $0.06