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Texas rates for HCPCS J0133

Injection, acyclovir, 5 mg

Facilitymedian $30 · 10th–90th $0–$3630%5%10th90th$30Professionalmedian $0 · 10th–90th $0–$00%50%10th$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
$16.98 / $58.88 / $602.56
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.08 / $0.26 / $0.52
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.06 / $0.12 / $0.12
Baylor Scott & White
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.58 / $0.58 / $0.58
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.02 / $0.05 / $0.14
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $0.02
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.12 / $48.98 / $549.54
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.10 / $0.59
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.04 / $0.04 / $0.12
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.02 / $0.06 / $0.17
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $0.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.05 / $0.07 / $0.07
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.04 / $0.12 / $0.12