Acyclovir intravenous antiviral solution

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.

Model: claude-sonnet-5-5
Provider: anthropic
API: message_batches
Reasoning effort: model default
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

ACYCLOVIR SODIUM 50 MG/ML IV SOLN

Payers reporting HCPCS J0133

Payer pricing summary

Low

Average

$55

Median

$30

High

$415

Payer rate distribution

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#
1	Florida Blue percent of total billed charges · bothfrom % of charges	1	$10	$10	$2	18%	96	$8 – $12
2	Caresource fee schedule · outpatient · +14 other terms	72	$0	$13	$16	128%	68	$0 – $39
3	Aetna fee schedule · outpatient · +23 other terms	290	$0	$20	$131	665%	42–420	$0 – $2.5k
4	Cigna fee schedule · outpatient · +22 other terms	413	$0	$16	$79	497%	32–50	$0 – $1.4k
5	Wellmark fee schedule · outpatient · +15 other terms	32	$0	$1	$17	1289%	15–150	$0 – $237
6	Blue Cross Blue Shield fee schedule · outpatient · +29 other terms	336	$0	$4	$35	897%	12–120	$0 – $1.5k
7	Anthem fee schedule · outpatient · +20 other terms	131	$0	$3	$16	568%	8–80	$0 – $299
8	UnitedHealthcare fee schedule · outpatient · +28 other terms	531	$0	$30	$563	1895%	4–40	$0 – $22.0k
9	Humana fee schedule · outpatient · +21 other terms	185	$0	$24	$59	245%	1–10	$0 – $564
10	MultiPlan fee schedule · outpatient · +16 other terms	89	$85	$140	$330	236%	—	$0 – $2.5k
11	Medica fee schedule · outpatient · +17 other terms	66	$31	$4	$14	392%	—	$0 – $118
12	Molina fee schedule · outpatient · +23 other terms	57	$0	$49	$363	744%	—	$0 – $4.9k
13	Highmark facility · fee schedule · outpatient · +14 other terms	56	$0	$3	$3	102%	—	$0 – $12
14	Kaiser fee schedule · both · +15 other terms	48	$0	$1	$2	255%	—	$0 – $8
15	Medcost percent of total billed charges · bothfrom % of charges · +5 other terms	44	$87	$110	$90	82%	—	$0 – $794
16	First Health fee schedule · outpatient · +14 other terms	36	$53	$76	$72	94%	—	$1 – $408
17	Regence facility · fee schedule · both · +14 other terms	32	$4	$8	$10	121%	—	$1 – $44
18	Excellus facility · fee schedule · both · +8 other terms	31	$3	$8	$10	115%	—	$1 – $44
19	Carefirst facility · fee schedule · both · +10 other terms	30	$3	$8	$10	120%	—	$1 – $44
20	Premera facility · fee schedule · both · +8 other terms	30	$3	$8	$10	122%	—	$1 – $44
21	Healthcare Highways percent of total billed charges · outpatientfrom % of charges · +2 other terms	29	$83	$92	$80	87%	—	$2 – $473
22	Medicaid facility · fee schedule · outpatient · +10 other terms	29	$4	$4	$5	124%	—	$0 – $33
23	Tricare facility · fee schedule · outpatient · +14 other terms	28	$29	$67	$60	89%	—	$0 – $231
24	Amerihealth Caritas facility · fee schedule · outpatient · +12 other terms	27	$0	$0	$0	25%	—	$0 – $0
25	Oscar facility · fee schedule · outpatient · +11 other terms	27	$0	$0	$0	60%	—	$0 – $0

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