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HCPCS J0133

Injection, acyclovir, 5 mg

Current code39 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.

HospitalCommercial insurance rates (lowest – highest)Cash priceList price (before discounts)
Cascade Medical CenterLeavenworth$30.00 – $35.112 plans$44.80$56.00
Cascade Valley HospitalArlington$2.75 – $1,5238 plans$25.86 – $137$32.33 – $171
Deaconess Medical CenterSpokaneFile dated 2026-08-27$1.00 – $2.322 plans$1.28$1.01 – $3.18
EvergreenHealth Medical CenterKirkland$5.00 – $44.647 plans$38.40$48.00
EvergreenHealth MonroeMonroe$32.13 – $47.4312 plans$40.80$51.00
Highline Medical CenterBurienFile dated 2026-02-28$26.86 – $2,5096 plans$19.07 – $851$62.45 – $2,788
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01—$34.61 – $71.49$49.44 – $102
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27$1.17 – $24.306 plans$1.59 – $12.16$1.79 – $30.38
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27$3.06 – $4.453 plans$2.08 – $2.44$5.19 – $6.10
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27$3.40 – $4.203 plans$2.31$1.04 – $5.76
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27$1.172 plans—$1.00 – $1.63
Olympic Medical CenterPort AngelesFile dated 2026-06-24$36.29 – $64.936 plans$51.94$64.93
Overlake Hospital Medical Center & ClinicsBellevueFile dated 2026-04-01—$4.88 – $9.75$9.75 – $19.50
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01—$70.66 – $77.57$101 – $111
Providence Centralia HospitalCentraliaFile dated 2026-04-01—$45.53$87.55
Providence Holy Family HospitalSpokaneFile dated 2026-04-01—$70.66 – $77.57$101 – $111
Providence Mount Carmel HospitalColvilleFile dated 2026-04-01—$70.66$101
Providence St Joseph HospitalChewelahFile dated 2026-04-01—$70.66$101
Providence St Mary Medical CenterWalla WallaFile dated 2026-04-01—$30.00 – $107$42.86 – $153
Providence St Peter HospitalOlympiaFile dated 2026-04-01—$45.53 – $106$87.55 – $205
Seattle Children's HospitalSeattle$101 – $17998 plans$187$187
Skagit Valley HospitalMount Vernon$4.67 – $1627 plans$25.86 – $137$32.33 – $171
St Anthony HospitalGig HarborFile dated 2026-02-28$34.35 – $2,0914 plans$19.00 – $848$62.45 – $2,788
St Clare HospitalLakewoodFile dated 2026-02-28$34.35 – $2,0914 plans$18.01 – $804$62.45 – $2,788
St Elizabeth HospitalEnumclawFile dated 2026-02-28$22.49 – $2,5099 plans$22.07 – $985$62.45 – $2,788
St Francis Community HospitalFederal WayFile dated 2026-02-28$34.35 – $2,0914 plans$19.60 – $875$62.45 – $2,788
St Joseph Medical CenterTacomaFile dated 2026-02-28$34.35 – $2,0914 plans$20.69 – $923$62.45 – $2,788
St Michael Medical CenterSilverdaleFile dated 2026-02-28$39.35 – $2,50910 plans$27.57 – $1,230$62.45 – $2,788
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01—$36.04$75.08
Swedish IssaquahIssaquahFile dated 2026-04-01—$36.04$75.08
Swedish Medical CenterSeattleFile dated 2026-04-01—$36.04$75.08
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01—$36.04$75.08
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27$1.102 plans—$1.22 – $1.50
Yakima Valley MemorialYakimaFile dated 2026-08-27$2.89 – $3.431 plan$2.07 – $2.46$5.16 – $6.13

Lowest and highest amounts each hospital lists for this code during a hospital stay, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

CMS publishes no national amount for this code.