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Pennsylvania rates for HCPCS J0133

Injection, acyclovir, 5 mg

Facilitymedian $13 · 10th–90th $0$2510%10%20%10th90th$13Professionalmedian $0 · 10th–90th $0$00%50%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
$5.13 / $16.60 / $251.19
AmeriHealth
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.18
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.11 / $0.13 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.12 / $0.12 / $0.12
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.02 / $0.07 / $0.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $0.02
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $0.02
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.03 / $0.03 / $0.03
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.13 / $0.54 / $5.50
Independence Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.13 / $0.13 / $0.15
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.03 / $0.05 / $0.11
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.03 / $0.05 / $0.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.12 / $0.12 / $0.17