Acyclovir intravenous antiviral solution at AMH Cath Labs LLC

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 INTRAVENOUS SOLN [4257]

Arlington, TX

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Pricing by billing methodology

Price type

How this price compares nationally

AMH Cath Labs LLC’s median price of $60 is 1140% above the median hospital's median price ($5), higher than 83% of the 2,202 hospitals reporting HCPCS J0133. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS J0133 at AMH Cath Labs LLC

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 exchange fee schedule · outpatient	$0	$0	—	—	—	$0 – $0
2	Blue Cross Blue Shield hmo fee schedule · outpatient	$0	$0	—	—	—	$0 – $0
3	Blue Cross Blue Shield ppo fee schedule · outpatient	$0	$0	—	—	—	$0 – $0
4	Blue Cross Blue Shield traditional fee schedule · outpatient	$1	$1	—	—	—	$1 – $1
5	Blue Cross Blue Shield managed medicaid percent of total billed charges · outpatientfrom % of charges	$10	$10	$3	26%	—	$8 – $13
6	UnitedHealthcare managed medicaid percent of total billed charges · outpatientfrom % of charges	$10	$10	$3	26%	—	$8 – $13
7	WellCare managed medicaid percent of total billed charges · outpatientfrom % of charges	$11	$11	$3	26%	—	$8 – $14
8	Molina managed medicaid percent of total billed charges · outpatientfrom % of charges	$11	$11	$3	26%	—	$8 – $14
9	Aetna managed medicaid percent of total billed charges · outpatientfrom % of charges	$11	$11	$3	26%	—	$8 – $14
10	Aetna whole health percent of total billed charges · inpatientfrom % of charges	$40	$40	$11	26%	—	$30 – $51
11	Aetna whole health percent of total billed charges · outpatientfrom % of charges	$48	$48	$13	26%	—	$35 – $60
12	Aetna commercial percent of total billed charges · inpatientfrom % of charges	$54	$54	$14	26%	—	$40 – $68
13	UnitedHealthcare all payer percent of total billed charges · outpatientfrom % of charges	$60	$60	$16	26%	—	$44 – $76
14	Aetna commercial percent of total billed charges · outpatientfrom % of charges	$64	$64	$17	26%	—	$47 – $80
15	UnitedHealthcare ppo percent of total billed charges · outpatientfrom % of charges	$64	$64	$17	26%	—	$47 – $81
16	Cigna oap/hmo percent of total billed charges · outpatientfrom % of charges	$64	$64	$17	26%	—	$47 – $81
17	Phcs ppo percent of total billed charges · outpatientfrom % of charges	$81	$81	$21	26%	—	$60 – $102
18	Cigna ppo percent of total billed charges · outpatientfrom % of charges	$81	$81	$21	26%	—	$60 – $102
19	Aetna asa percent of total billed charges · outpatientfrom % of charges	$82	$82	$21	26%	—	$60 – $103
20	Aetna coventry percent of total billed charges · outpatientfrom % of charges	$82	$82	$21	26%	—	$60 – $103
21	Phcs ppo percent of total billed charges · inpatientfrom % of charges	$87	$87	$23	26%	—	$64 – $110
22	MultiPlan commercial percent of total billed charges · inpatientfrom % of charges	$101	$101	$27	26%	—	$75 – $128
23	MultiPlan commercial percent of total billed charges · outpatientfrom % of charges	$101	$101	$27	26%	—	$75 – $128
24	Cigna indemnity percent of total billed charges · inpatientfrom % of charges	$110	$110	$29	26%	—	$81 – $138
25	Cigna indemnity percent of total billed charges · outpatientfrom % of charges	$110	$110	$29	26%	—	$81 – $138

Last updated: Apr 21, 2026

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