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/ML VIAL INJ
Monroeville, PA
See all hospitals reporting HCPCS J0133 →Price type
UPMC East’s median price of $4 is 20% below the median hospital's median price ($5), higher than 48% 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: 6 payers, 34 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 | Amerihealth Caritas community healthchoices (chc)/medicaid facility · fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 2 | Highmark medicaid facility · fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 3 | UnitedHealthcare all business facility · fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 4 | UnitedHealthcare compass exchange facility · fee schedule · outpatient | $0 | $0 | — | — | — | $0 – $0 |
| 5 | Highmark complete blue medicare advantage/freedom blue medicare advantage/security blue medicare advantage facility · fee schedule · outpatient | $1 | $1 | — | — | — | $1 – $1 |
| 6 | Highmark managed care - social mission facility · fee schedule · outpatient | $4 | $4 | — | — | — | $4 – $4 |
| 7 | Highmark commercial - social mission indemnity facility · fee schedule · outpatient | $4 | $4 | — | — | — | $4 – $4 |
| 8 | Highmark managed care facility · fee schedule · outpatient | $5 | $5 | — | — | — | $5 – $5 |
| 9 | Highmark commercial - indemnity facility · fee schedule · outpatient | $5 | $5 | — | — | — | $5 – $5 |
| 10 | Highmark upmc emergent facility · fee schedule · outpatient | $11 | $11 | — | — | — | $11 – $11 |
| 11 | Aetna medicare facility · percent of total billed charges · outpatientfrom % of charges | $3 | $106 | $127 | 120% | — | $3 – $261 |
| 12 | UnitedHealthcare compass exchange facility · percent of total billed charges · inpatientfrom % of charges | $3 | $144 | $172 | 120% | — | $3 – $355 |
| 13 | Aetna neighborhood network facility · percent of total billed charges · outpatientfrom % of charges | $4 | $149 | $178 | 120% | — | $4 – $367 |
| 14 | Aetna neighborhood network facility · percent of total billed charges · inpatientfrom % of charges | $4 | $153 | $183 | 120% | — | $4 – $376 |
| 15 | Aetna ebr fi facility · percent of total billed charges · inpatientfrom % of charges | $4 | $161 | $193 | 120% | — | $4 – $397 |
| 16 | Aetna ebr fi facility · percent of total billed charges · outpatientfrom % of charges | $4 | $161 | $193 | 120% | — | $4 – $397 |
| 17 | Aetna home depot employer group facility · percent of total billed charges · outpatientfrom % of charges | $4 | $162 | $194 | 120% | — | $4 – $399 |
| 18 | Aetna nbr aso/fi facility · percent of total billed charges · outpatientfrom % of charges | $4 | $165 | $198 | 120% | — | $4 – $408 |
| 19 | Cigna nbr aso/fi facility · percent of total billed charges · outpatientfrom % of charges | $4 | $165 | $198 | 120% | — | $4 – $408 |
| 20 | Cigna new business aso facility · percent of total billed charges · outpatientfrom % of charges | $4 | $165 | $198 | 120% | — | $4 – $408 |
| 21 | Aetna home depot employer group facility · percent of total billed charges · inpatientfrom % of charges | $4 | $166 | $199 | 120% | — | $4 – $410 |
| 22 | Aetna ebr aso facility · percent of total billed charges · inpatientfrom % of charges | $4 | $170 | $203 | 120% | — | $4 – $418 |
| 23 | Aetna ebr aso facility · percent of total billed charges · outpatientfrom % of charges | $4 | $170 | $203 | 120% | — | $4 – $418 |
| 24 | Aetna nbr aso/fi facility · percent of total billed charges · inpatientfrom % of charges | $4 | $170 | $203 | 120% | — | $4 – $418 |
| 25 | Cigna commercial facility · percent of total billed charges · inpatientfrom % of charges | $4 | $170 | $203 | 120% | — | $4 – $418 |
Last updated: Mar 6, 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.