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Every billing code / Treatments and drugs / Injections and Infusions (nononcologic)

HCPCS J0133

Injection, acyclovir, 5 mg

Current code46 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Other government program: TRICARE, VA, Indian Health Service, workers' compensation, or another public program.

HospitalOther government program rates (lowest – highest)Cash priceList price (before discounts)
Arbor Health Morton HospitalMortonFile dated 2026-05-18—$24.53$39.56
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
Kittitas Valley Community HospitalEllensburgFile dated 2026-10-07—$204$240
Legacy Salmon Creek Medical CenterVancouverFile dated 2026-04-01—$14.30$22.00
Lincoln HospitalDavenportFile dated 2026-09-14$31.993 plans$51.42$57.13
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
PeaceHealth Peace Island Medical CenterFriday Harbor—$1.98 – $131$3.05 – $202
PeaceHealth Southwest Medical CenteVancouver—$115 – $131$177 – $202
PeaceHealth St John Medical CenterLongview—$4.03 – $131$6.20 – $202
PeaceHealth St Joseph Medical CenterBellingham—$115 – $148$177 – $227
PeaceHealth United General Medical CenterSedro Woolley—$116 – $131$179 – $202
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
Quincy Valley Medical CenterQuincyFile dated 2026-05-27—$91.37$91.37
Seattle Children's HospitalSeattle$76.471 plan$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
Summit Pacific Medical CenterElmaFile dated 2026-08-31$29.081 plan$62.81$116
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
WhidbeyHealth Medical CenterCoupeville—$42.40$42.40
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 as an outpatient, 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.