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
ACYCLOVIR SODIUM 50 MG/ML IV SOLN
ST, LA
See all hospitals reporting HCPCS J0133 →Price type
Kaplan General Hospital, Inc’s median price of $104 is 1955% above the median hospital's median price ($5), higher than 93% of the 2,220 hospitals reporting HCPCS J0133. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 10 payers, 12 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 | Bcbs La all payor fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 2 | Bcbs La all payor other · outpatient | $104 | $104 | — | — | — | $104 – $104 |
| 3 | Optum all payor other · outpatient | $104 | $104 | — | — | — | $104 – $104 |
| 4 | WellCare all payor other · outpatient | $104 | $104 | — | — | — | $104 – $104 |
| 5 | Tricare all payor percent of total billed charges · outpatientfrom % of charges | $121 | $121 | — | — | — | $121 – $121 |
| 6 | Aetna all payor other · outpatient | $127 | $127 | $23 | 18% | — | $104 – $150 |
| 7 | Humana all payor other · outpatient | $141 | $141 | $38 | 27% | — | $104 – $179 |
| 8 | UnitedHealthcare all payor other · outpatient | $141 | $141 | $38 | 27% | — | $104 – $179 |
| 9 | Aetna all payor other · inpatient | $150 | $150 | — | — | — | $150 – $150 |
| 10 | Cigna all payor other · outpatient | $161 | $161 | — | — | — | $161 – $161 |
| 11 | Aetna Better Health all payor other · outpatient | $179 | $179 | — | — | — | $179 – $179 |
| 12 | Amerihealth Caritas all payor other · outpatient | $179 | $179 | — | — | — | $179 – $179 |
Last updated: Apr 1, 2026
See Acyclovir intravenous antiviral solution pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.