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.
Original text from hospital filings
ACYCLOVR 50MG/ML 10ML INJ
Gilbert, AZ
See all hospitals reporting HCPCS J0133 →Price type
Dignity Health’s median price of $0 is 97% below the median hospital's median price ($5), higher than 22% of the 2,187 hospitals reporting HCPCS J0133. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 6 payers, 17 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 | Cigna commercial|exchange fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 2 | Cigna commercial|localplus surefit fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 3 | UnitedHealthcare medicaid|all plans fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 4 | Cigna commercial|all other plans fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 5 | Cigna commercial|ppo fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 6 | Blue Cross Blue Shield commercial|all other plans fee schedule · outpatient | $0 | $0 | — | — | 2–20 | $0 – $0 |
| 7 | Blue Cross Blue Shield commercial|maricopafocus fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 8 | Blue Cross Blue Shield commercial|neighborhood fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 9 | Blue Cross Blue Shield commercial|workers comp fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 10 | Aetna commercial|all other plans fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 11 | Aetna commercial|hmo fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 12 | Aetna commercial|ppo fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 13 | UnitedHealthcare commercial|dignityhealthemployee fee schedule · outpatient | $11 | $11 | $11 | 99% | — | $0 – $21 |
| 14 | First Health commercial|all plans fee schedule · inpatient | $42 | $42 | $41 | 99% | — | $1 – $83 |
| 15 | First Health commercial|all plans fee schedule · outpatient | $42 | $42 | $41 | 99% | — | $1 – $83 |
| 16 | MultiPlan commercial|all plans fee schedule · inpatient | $59 | $59 | $59 | 99% | — | $1 – $118 |
| 17 | MultiPlan commercial|all plans fee schedule · outpatient | $59 | $59 | $59 | 99% | — | $1 – $118 |
Last updated: Feb 28, 2026
See Acyclovir intravenous antiviral solution pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.