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
FOSCAVIR 24 MG/ML INTRAVENOUS SOLUTION
Eureka, IL
See all hospitals reporting HCPCS J1455 →Price type
Carle Eureka Hospital’s median price of $302 is 404% above the median hospital's median price ($60), higher than 76% of the 1,616 hospitals reporting HCPCS J1455. 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, 20 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 | UnitedHealthcare va ccn/optum fee schedule · inpatient | $55 | $55 | — | — | — | $55 – $55 |
| 2 | UnitedHealthcare va ccn/optum fee schedule · outpatient | $55 | $55 | — | — | — | $55 – $55 |
| 3 | Humana medicare-medicaid (d-snp) fee schedule · inpatient | $67 | $67 | — | — | — | $67 – $67 |
| 4 | Humana medicare-medicaid (d-snp) fee schedule · outpatient | $67 | $67 | — | — | — | $67 – $67 |
| 5 | Aetna Better Health medicare-medicaid (d-snp) fee schedule · inpatient | $69 | $69 | — | — | — | $69 – $69 |
| 6 | Aetna Better Health medicare-medicaid (d-snp) fee schedule · outpatient | $69 | $69 | — | — | — | $69 – $69 |
| 7 | Molina managed medicaid percent of total billed charges · inpatientfrom % of charges | $403 | $403 | $310 | 77% | — | $93 – $714 |
| 8 | Molina managed medicaid percent of total billed charges · outpatientfrom % of charges | $403 | $403 | $310 | 77% | — | $93 – $714 |
| 9 | Molina medicare-medicaid (d-snp) percent of total billed charges · inpatientfrom % of charges | $403 | $403 | $310 | 77% | — | $93 – $714 |
| 10 | Aetna medicare advantage percent of total billed charges · outpatientfrom % of charges | $908 | $908 | $699 | 77% | — | $209 – $1.6k |
| 11 | Humana medicare advantage percent of total billed charges · outpatientfrom % of charges | $908 | $908 | $699 | 77% | — | $209 – $1.6k |
| 12 | UnitedHealthcare medicare advantage percent of total billed charges · outpatientfrom % of charges | $908 | $908 | $699 | 77% | — | $209 – $1.6k |
| 13 | Molina medicare-medicaid (d-snp) percent of total billed charges · outpatientfrom % of charges | $968 | $968 | $745 | 77% | — | $223 – $1.7k |
| 14 | UnitedHealthcare ppo percent of total billed charges · outpatientfrom % of charges | $1.2k | $1.2k | $958 | 77% | — | $287 – $2.2k |
| 15 | Cigna ppo percent of total billed charges · outpatientfrom % of charges | $1.3k | $1.3k | $962 | 77% | — | $288 – $2.2k |
| 16 | Aetna ppo percent of total billed charges · inpatientfrom % of charges | $1.3k | $1.3k | $1.0k | 77% | — | $307 – $2.4k |
| 17 | Aetna ppo percent of total billed charges · outpatientfrom % of charges | $1.3k | $1.3k | $1.0k | 77% | — | $307 – $2.4k |
| 18 | Blue Cross Blue Shield hmo percent of total billed charges · outpatientfrom % of charges | $1.4k | $1.4k | $1.0k | 77% | — | $312 – $2.4k |
| 19 | MultiPlan ppo percent of total billed charges · outpatientfrom % of charges | $1.5k | $1.5k | $1.2k | 77% | — | $349 – $2.7k |
| 20 | Blue Cross Blue Shield blue choice/options/ppo percent of total billed charges · outpatientfrom % of charges | $1.7k | $1.7k | $1.3k | 77% | — | $391 – $3.0k |
Last updated: Apr 15, 2026
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