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
ACYCLOVIR 5MG/1ML PEDIV
Phoenix, AZ
See all hospitals reporting HCPCS J0133 →Price type
Dignity Health’s median price of $13 is 157% above the median hospital's median price ($5), higher than 57% of the 2,220 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: 7 payers, 16 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 | — | — | 2–20 | $0 – $0 |
| 5 | Blue Cross Blue Shield commercial|all other plans fee schedule · outpatient | $0 | $0 | — | — | 2–20 | $0 – $0 |
| 6 | Blue Cross Blue Shield commercial|maricopafocus fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 7 | Blue Cross Blue Shield commercial|neighborhood fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 8 | Blue Cross Blue Shield commercial|workers comp fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 9 | Aetna commercial|all plans fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 10 | UnitedHealthcare commercial|dignityhealthemployee fee schedule · outpatient | $9 | $9 | $4 | 47% | — | $5 – $14 |
| 11 | Optum commercial|optumhealth fee schedule · outpatient | $23 | $23 | $11 | 47% | — | $12 – $34 |
| 12 | Cigna commercial|lifesource fee schedule · outpatient | $27 | $27 | $13 | 47% | — | $14 – $40 |
| 13 | First Health commercial|all plans fee schedule · inpatient | $34 | $34 | $16 | 47% | — | $18 – $50 |
| 14 | First Health commercial|all plans fee schedule · outpatient | $34 | $34 | $16 | 47% | — | $18 – $50 |
| 15 | MultiPlan commercial|all plans fee schedule · inpatient | $39 | $39 | $18 | 47% | — | $21 – $57 |
| 16 | MultiPlan commercial|all plans fee schedule · outpatient | $39 | $39 | $18 | 47% | — | $21 – $57 |
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.