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Washington rates for HCPCS J0133

Injection, acyclovir, 5 mg

Facilitymedian $66 · 10th–90th $4–$2450%5%10%10th90th$66Professionalmedian $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
$7.59 / $66.07 / $245.47
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $0.02
Asuris Northwest Health
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
$0.03 / $0.03 / $0.10
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $0.02
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.03 / $0.04 / $0.08
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.04 / $0.14 / $0.14
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.03 / $0.04 / $0.04
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $0.02
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $0.02
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.04 / $0.04 / $0.09
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.04 / $0.12 / $0.12
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $0.03