Acyclovir intravenous antiviral solution at Samaritan Hospital

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 5 MG/ML IN NS IV SYRINGE (NEO/PED) - CNR

Troy, NY

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How this price compares nationally

Samaritan Hospital’s median price of $8 is 56% above the median hospital's median price ($5), higher than 53% of the 2,220 hospitals reporting HCPCS J0133. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS J0133 at Samaritan Hospital

Negotiated rates from the hospital’s own file: 15 payers, 27 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 united healthcare medicaid harp chip facility · fee schedule · both	$2	$2	$2	74%	—	$1 – $4
2	UnitedHealthcare united healthcare facility · fee schedule · both	$6	$6	$4	74%	—	$1 – $10
3	First Health first health facility · percent of total billed charges · bothfrom % of charges	$6	$6	$4	61%	—	$2 – $10
4	MultiPlan beech street facility · percent of total billed charges · bothfrom % of charges	$7	$7	$4	61%	—	$3 – $11
5	MultiPlan multiplan facility · percent of total billed charges · bothfrom % of charges	$7	$7	$4	61%	—	$3 – $11
6	Phcs multiplan facility · percent of total billed charges · bothfrom % of charges	$7	$7	$4	61%	—	$3 – $11
7	UnitedHealthcare united healthcare facility · percent of total billed charges · bothfrom % of charges	$8	$8	$5	61%	—	$3 – $12
8	UnitedHealthcare uhc essential plan medicaid facility · fee schedule · both	$8	$8	$6	74%	—	$2 – $14
9	Anthem empire medicaid facility · fee schedule · both	$14	$14	$10	74%	—	$4 – $24
10	Anthem empire medicaid essential 1 2 3 4 facility · fee schedule · both	$14	$14	$10	74%	—	$4 – $24
11	Excellus empire medicaid facility · fee schedule · both	$14	$14	$10	74%	—	$4 – $24
12	Excellus empire medicaid essential 1 2 3 4 facility · fee schedule · both	$14	$14	$10	74%	—	$4 – $24
13	Blue Cross Blue Shield blue shield of ne new york hmo facility · fee schedule · both	$14	$14	$11	74%	—	$4 – $25
14	Blue Cross Blue Shield blue shield of ne new york ppo facility · fee schedule · both	$14	$14	$11	74%	—	$4 – $25
15	Carefirst blue shield of ne new york hmo facility · fee schedule · both	$14	$14	$11	74%	—	$4 – $25
16	Carefirst blue shield of ne new york ppo facility · fee schedule · both	$14	$14	$11	74%	—	$4 – $25
17	Excellus blue shield of ne new york ppo facility · fee schedule · both	$14	$14	$11	74%	—	$4 – $25
18	Highmark blue shield of ne new york ascend facility · fee schedule · both	$14	$14	$11	74%	—	$4 – $25
19	Highmark blue shield of ne new york hmo facility · fee schedule · both	$14	$14	$11	74%	—	$4 – $25
20	Highmark blue shield of ne new york ppo facility · fee schedule · both	$14	$14	$11	74%	—	$4 – $25
21	Premera blue shield of ne new york ppo facility · fee schedule · both	$14	$14	$11	74%	—	$4 – $25
22	Regence blue shield of ne new york ppo facility · fee schedule · both	$14	$14	$11	74%	—	$4 – $25
23	Wellmark blue shield of ne new york hmo facility · fee schedule · both	$14	$14	$11	74%	—	$4 – $25
24	Wellmark blue shield of ne new york ppo facility · fee schedule · both	$14	$14	$11	74%	—	$4 – $25
25	Cigna cigna facility · fee schedule · both	$21	$21	$15	74%	—	$5 – $36

Page 1 of 2 · 27 rates

Last updated: Mar 31, 2026

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