Acyclovir intravenous antiviral solution at St Michael's 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 500 MG/10 ML Vial

Tyndall, SD

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How this price compares nationally

St Michael's Hospital’s median price of $175 is 3515% above the median hospital's median price ($5), higher than 97% 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 St Michael's Hospital

Negotiated rates from the hospital’s own file: 4 payers, 11 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	Medica com fee schedule · outpatient	$31	$31	—	—	—	$31 – $31
2	Medica ind fee schedule · outpatient	$31	$31	—	—	—	$31 – $31
3	Medica ind percent of total billed charges · inpatientfrom % of charges	$120	$120	—	—	—	$120 – $120
4	Medica com percent of total billed charges · inpatientfrom % of charges	$142	$142	—	—	—	$142 – $142
5	UnitedHealthcare com percent of total billed charges · inpatientfrom % of charges	$157	$157	—	—	—	$157 – $157
6	UnitedHealthcare com percent of total billed charges · outpatientfrom % of charges	$157	$157	—	—	—	$157 – $157
7	Healthpartners com percent of total billed charges · inpatientfrom % of charges	$175	$175	—	—	—	$175 – $175
8	Healthpartners com percent of total billed charges · outpatientfrom % of charges	$175	$175	—	—	—	$175 – $175
9	Wellmark ppo percent of total billed charges · inpatientfrom % of charges	$184	$184	—	—	—	$184 – $184
10	Wellmark ppo percent of total billed charges · outpatientfrom % of charges	$184	$184	—	—	1–10	$184 – $184
11	Wellmark hmo outpatient	$185	$185	—	—	1–10	$185 – $185

Last updated: Apr 1, 2026

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