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New Hampshire rates for HCPCS J0133

Injection, acyclovir, 5 mg

Facilitymedian $6 · 10th–90th $0–$7760%10%10th90th$6Professionalmedian $0 · 10th–90th $0–$00%20%40%10th90th$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
$5.75 / $562.34 / $776.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.03 / $0.04 / $0.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $0.12
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.02 / $0.04 / $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 / $0.04 / $0.07
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.03 / $0.12 / $0.12