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Montana rates for HCPCS J0133

Injection, acyclovir, 5 mg

Facilitymedian $0 · 10th–90th $0–$850%20%40%10th90th$0Professionalmedian $0 · 10th–90th $0–$00%20%40%10th90th$0$0.0$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$56.23 / $56.23 / $147.91
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.13 / $46,773.51 / $91,201.08
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.04 / $0.04 / $0.20
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $0.04
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.05 / $0.06 / $0.16
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.05 / $0.06 / $0.16
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.04 / $0.04 / $0.20
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $79.43 / $85.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.12 / $0.12 / $0.12