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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

Medicare (traditional): Traditional Medicare. Applies only to people on original Medicare.

HospitalMedicare (traditional) rates (lowest – highest)Cash priceList price (before discounts)
Cascade Medical CenterLeavenworth$32.381 plan$44.80$56.00
Cascade Valley HospitalArlington—$25.86 – $137$32.33 – $171
Deaconess Medical CenterSpokaneFile dated 2026-08-27—$1.28$1.01 – $3.18
EvergreenHealth Medical CenterKirkland—$38.40$48.00
EvergreenHealth MonroeMonroe—$40.80$51.00
Highline Medical CenterBurienFile dated 2026-02-28—$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—$1.59 – $12.16$1.79 – $30.38
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27—$2.08 – $2.44$5.19 – $6.10
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27—$2.31$1.04 – $5.76
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27——$1.00 – $1.63
Olympic Medical CenterPort AngelesFile dated 2026-06-24—$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—$187$187
Skagit Valley HospitalMount Vernon—$25.86 – $137$32.33 – $171
St Anthony HospitalGig HarborFile dated 2026-02-28—$19.00 – $848$62.45 – $2,788
St Clare HospitalLakewoodFile dated 2026-02-28—$18.01 – $804$62.45 – $2,788
St Elizabeth HospitalEnumclawFile dated 2026-02-28—$22.07 – $985$62.45 – $2,788
St Francis Community HospitalFederal WayFile dated 2026-02-28—$19.60 – $875$62.45 – $2,788
St Joseph Medical CenterTacomaFile dated 2026-02-28—$20.69 – $923$62.45 – $2,788
St Michael Medical CenterSilverdaleFile dated 2026-02-28—$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——$1.22 – $1.50
Yakima Valley MemorialYakimaFile dated 2026-08-27—$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.