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West Virginia rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.12 / $17.38 / $114.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.12 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.43 / $0.43
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.13