NDC 904578961
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.
Generation details were not recorded for this description.
Original text from hospital filings
00904-5789-61 - acyclovir 200 mg Cap
Reported by 9 hospitals in the network under the per diem methodology.
Low
$1
Average
$1.0k
Median
$3
High
$3.9k
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Reflects a negotiated per diem rate paid per day of care.
Showing only prices reported under the per diem methodology. Choose another in the filter above to change the chart. 9 hospitals; the 90th percentile is 2812.8× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
Click a bar to filter the hospitals table to that price range.
| # | Hospital | ||||||
|---|---|---|---|---|---|---|---|
| 1 | Dukes Health System LLC Peru, IN | $1 | $1 | — | — | — | $1 – $7 |
| 2 | Victoria of Texas LP Victoria, TX | $2 | $3 | $1 | 48% | — | $2 – $35 |
| 3 | Victoria of Texas LP Victoria, TX | $2 | $3 | $1 | 48% | — | $2 – $35 |
| 4 | Affinity Hospital LLC Birmingham, AL | $13 | $13 | — | — | — | $7 – $43 |
| 5 | Gadsden Regional Medical Center LLC Gadsden, AL | $1.5k | $1.5k | — | — | — | $0 – $1.5k |
| 6 | Laredo Texas Hospital Company LP Laredo, TX | $1 | $1 | $0 | 33% | — | $1 – $14 |
| 7 | Longview Medical Center LP Longview, TX | $1 | $2 | $1 | 41% | — | $1 – $34 |
| 8 | Arkansas Childrens Hospital Little Rock, AR | $3.9k | $3.9k | $437 | 11% | — | $3.1k – $5.2k |
| 9 | Arkansas Childrens Northwest Springdale, AR | $3.6k | $3.5k | $227 | 6% | — | $3.1k – $5.2k |
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