Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLR [522]
Arlington, TX
See all hospitals reporting HCPCS J1570 →Price type
AMH Cath Labs LLC’s median price of $164 is 90% above the median hospital's median price ($86), higher than 74% of the 1,888 hospitals reporting HCPCS J1570. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 8 payers, 25 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Blue Cross Blue Shield managed medicaid percent of total billed charges · outpatientfrom % of charges | $26 | $26 | $5 | 20% | — | $21 – $31 |
| 2 | UnitedHealthcare managed medicaid percent of total billed charges · outpatientfrom % of charges | $26 | $26 | $5 | 20% | — | $21 – $31 |
| 3 | WellCare managed medicaid percent of total billed charges · outpatientfrom % of charges | $27 | $27 | $5 | 20% | — | $22 – $33 |
| 4 | Molina managed medicaid percent of total billed charges · outpatientfrom % of charges | $28 | $28 | $6 | 20% | — | $22 – $34 |
| 5 | Aetna managed medicaid percent of total billed charges · outpatientfrom % of charges | $29 | $29 | $6 | 20% | — | $23 – $34 |
| 6 | Blue Cross Blue Shield hmo fee schedule · outpatient | $85 | $85 | — | — | — | $85 – $85 |
| 7 | Blue Cross Blue Shield exchange fee schedule · outpatient | $87 | $87 | — | — | — | $87 – $87 |
| 8 | Blue Cross Blue Shield ppo fee schedule · outpatient | $94 | $94 | — | — | — | $94 – $94 |
| 9 | Aetna whole health percent of total billed charges · inpatientfrom % of charges | $101 | $101 | $20 | 20% | — | $81 – $121 |
| 10 | Aetna whole health percent of total billed charges · outpatientfrom % of charges | $120 | $120 | $24 | 20% | — | $96 – $144 |
| 11 | Aetna commercial percent of total billed charges · inpatientfrom % of charges | $135 | $135 | $27 | 20% | — | $108 – $161 |
| 12 | UnitedHealthcare all payer percent of total billed charges · outpatientfrom % of charges | $151 | $151 | $30 | 20% | — | $121 – $181 |
| 13 | Aetna commercial percent of total billed charges · outpatientfrom % of charges | $160 | $160 | $32 | 20% | — | $128 – $192 |
| 14 | UnitedHealthcare ppo percent of total billed charges · outpatientfrom % of charges | $160 | $160 | $32 | 20% | — | $128 – $192 |
| 15 | Cigna oap/hmo percent of total billed charges · outpatientfrom % of charges | $161 | $161 | $32 | 20% | — | $129 – $194 |
| 16 | Phcs ppo percent of total billed charges · outpatientfrom % of charges | $203 | $203 | $40 | 20% | — | $163 – $243 |
| 17 | Cigna ppo percent of total billed charges · outpatientfrom % of charges | $204 | $204 | $40 | 20% | — | $163 – $244 |
| 18 | Aetna asa percent of total billed charges · outpatientfrom % of charges | $205 | $205 | $41 | 20% | — | $164 – $245 |
| 19 | Aetna coventry percent of total billed charges · outpatientfrom % of charges | $205 | $205 | $41 | 20% | — | $164 – $245 |
| 20 | Phcs ppo percent of total billed charges · inpatientfrom % of charges | $218 | $218 | $43 | 20% | — | $174 – $261 |
| 21 | MultiPlan commercial percent of total billed charges · inpatientfrom % of charges | $254 | $254 | $51 | 20% | — | $204 – $305 |
| 22 | MultiPlan commercial percent of total billed charges · outpatientfrom % of charges | $254 | $254 | $51 | 20% | — | $204 – $305 |
| 23 | Cigna indemnity percent of total billed charges · inpatientfrom % of charges | $275 | $275 | $55 | 20% | — | $220 – $330 |
| 24 | Cigna indemnity percent of total billed charges · outpatientfrom % of charges | $275 | $275 | $55 | 20% | — | $220 – $330 |
| 25 | Blue Cross Blue Shield traditional fee schedule · outpatient | $386 | $386 | — | — | — | $386 – $386 |
Last updated: Apr 21, 2026
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