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Wisconsin rates for HCPCS J0133

Injection, acyclovir, 5 mg

Facilitymedian $2 · 10th–90th $0$2570%10%10th90th$2Professionalmedian $0 · 10th–90th $0$10%50%90th$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
$114.82 / $131.83 / $691.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.03 / $0.03 / $0.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $0.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.03 / $0.08 / $0.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.14 / $0.23
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.04 / $0.04 / $0.71
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.06 / $0.08 / $0.26
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.03 / $0.03 / $2.34
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.03 / $0.03 / $0.08
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.12 / $64.57 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.06 / $0.06 / $0.06
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.03 / $1.00
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.12 / $0.12 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.12 / $0.12 / $0.12
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.03 / $0.03 / $0.03
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
$0.12 / $0.12 / $0.16