4460093 — Acyclovir 5% 30gm Top
Cite this view
HANK Price Transparency. (n.d.). ACYCLOVIR 5% 30GM TOP (CDM 4460093) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/4460093?code_type=CDM
“ACYCLOVIR 5% 30GM TOP (CDM 4460093) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/4460093?code_type=CDM. Accessed .
“ACYCLOVIR 5% 30GM TOP (CDM 4460093) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/4460093?code_type=CDM.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $2,236–$3,465 (25th–75th percentile) across 2 hospitals · 10 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CDM 4460093 — the consumer-grade median across the country. It covers the facility charge only; the surgeon’s and anesthesiologist’s fees are billed separately.
Per-month price trends are temporarily unavailable while we rebuild them on quality-filtered rates. The medians, percentiles, and per-hospital rates on this page are the quality-filtered figures.
Hospital rates (per row)
Showing consumer-grade rates only. Flagged / outlier filings (excluded from the medians above) are hidden — tick “Show flagged / outlier rates” to include them.
| Hospital | Payer | Plan | Negotiated rate | Gross | Cash | Observed | Source |
|---|---|---|---|---|---|---|---|
| UCSF HEALTH ST. MARY'S HOSPITAL Inpatient | Health Plan San Mateo | Medicaid|< 21 | $819.72 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Inpatient | Health Plan San Mateo | Medicaid|< 21 | $819.72 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Inpatient | Health Plan San Mateo | Medicaid|> 21 | $819.72 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Inpatient | Health Plan San Mateo | Medicaid|> 21 | $819.72 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Outpatient | Cigna | Commercial|LocalPlus | $2,161.08 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Outpatient | Cigna | Commercial|LocalPlus | $2,161.08 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Inpatient | Magellan | Commercial|All Plans | $2,235.60 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Inpatient | Magellan | Commercial|All Plans | $2,235.60 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Outpatient | Cigna | Commercial|All Other Plans | $2,310.12 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Outpatient | Cigna | Commercial|All Other Plans | $2,310.12 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Inpatient | Healthsmart | Commercial|All Plans | $2,608.20 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Inpatient | Healthsmart | Commercial|All Plans | $2,608.20 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Outpatient | Kaiser | Commercial|All Plans | $2,831.76 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Outpatient | Kaiser | Commercial|All Plans | $2,831.76 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Outpatient | Chinese Community | Commercial|All Plans | $3,018.06 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Outpatient | Chinese Community | Commercial|All Plans | $3,018.06 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Inpatient | Multiplan | Commercial|All Plans | $3,092.58 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Inpatient | Multiplan | Commercial|All Plans | $3,092.58 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Outpatient | BCBS - Anthem | Commercial|All Other Plans | $3,465.18 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Outpatient | BCBS - Anthem | Commercial|All Other Plans | $3,465.18 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Outpatient | BCBS - Anthem | Commercial|MCS | $3,726.00 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Outpatient | BCBS - Anthem | Commercial|MCS | $3,726.00 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Outpatient | US Behavioral Health | Commercial|All Plans | $3,726.00 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| UCSF HEALTH ST. MARY'S HOSPITAL Outpatient | US Behavioral Health | Commercial|All Plans | $3,726.00 | $3,726.00 | $3,726.00 | 2026-02-28 | MRF ↗ |
| NORTHWEST MISSISSISSIPPI REGIONAL MEDICAL CENTER Both | SELF PAY | SELF PAY IVITA | $11,302.56 | $45,210.25 | $11,302.56 | 2026-04-08 | MRF ↗ |
| NORTHWEST MISSISSISSIPPI REGIONAL MEDICAL CENTER Both | SELF PAY | SELF PAY | $11,302.56 | $45,210.25 | $11,302.56 | 2026-04-08 | MRF ↗ |