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Maine rates for HCPCS J0133

Injection, acyclovir, 5 mg

Facilitymedian $126 · 10th–90th $91–$2690%20%10th90th$126Professionalmedian $0 · 10th–90th $0–$00%50%90th$0$0.0$0.1$0.5$2.0$10.0$50.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $125.89 / $269.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.06 / $0.06 / $0.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $0.02
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $0.06
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $0.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $0.12
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.12 / $0.17