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
ZOLEDRONIC AC-MANNITOL-0.9NACL 4 MG/100 ML INTRAVENOUS PGBK [122449]
Arlington, TX
See all hospitals reporting HCPCS J3489 →Price type
AMH Cath Labs LLC’s median price of $384 is 471% above the median hospital's median price ($67), higher than 81% of the 2,262 hospitals reporting HCPCS J3489. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 8 payers, 25 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 | Blue Cross Blue Shield hmo fee schedule · outpatient | $14 | $14 | — | — | — | $14 – $14 |
| 2 | Blue Cross Blue Shield exchange fee schedule · outpatient | $14 | $14 | — | — | — | $14 – $14 |
| 3 | Blue Cross Blue Shield ppo fee schedule · outpatient | $15 | $15 | — | — | — | $15 – $15 |
| 4 | Blue Cross Blue Shield traditional fee schedule · outpatient | $63 | $63 | — | — | — | $63 – $63 |
| 5 | Blue Cross Blue Shield managed medicaid percent of total billed charges · outpatientfrom % of charges | $58 | $152 | $141 | 93% | — | $16 – $384 |
| 6 | UnitedHealthcare managed medicaid percent of total billed charges · outpatientfrom % of charges | $58 | $152 | $141 | 93% | — | $16 – $384 |
| 7 | WellCare managed medicaid percent of total billed charges · outpatientfrom % of charges | $61 | $159 | $148 | 93% | — | $16 – $404 |
| 8 | Molina managed medicaid percent of total billed charges · outpatientfrom % of charges | $62 | $164 | $152 | 93% | — | $17 – $415 |
| 9 | Aetna managed medicaid percent of total billed charges · outpatientfrom % of charges | $63 | $167 | $155 | 93% | — | $17 – $423 |
| 10 | Aetna whole health percent of total billed charges · inpatientfrom % of charges | $224 | $590 | $546 | 93% | — | $60 – $1.5k |
| 11 | Aetna whole health percent of total billed charges · outpatientfrom % of charges | $266 | $700 | $649 | 93% | — | $72 – $1.8k |
| 12 | Aetna commercial percent of total billed charges · inpatientfrom % of charges | $299 | $786 | $728 | 93% | — | $80 – $2.0k |
| 13 | UnitedHealthcare all payer percent of total billed charges · outpatientfrom % of charges | $335 | $882 | $817 | 93% | — | $90 – $2.2k |
| 14 | Aetna commercial percent of total billed charges · outpatientfrom % of charges | $355 | $933 | $865 | 93% | — | $95 – $2.4k |
| 15 | UnitedHealthcare ppo percent of total billed charges · outpatientfrom % of charges | $355 | $934 | $866 | 93% | — | $95 – $2.4k |
| 16 | Cigna oap/hmo percent of total billed charges · outpatientfrom % of charges | $358 | $942 | $873 | 93% | — | $96 – $2.4k |
| 17 | Phcs ppo percent of total billed charges · outpatientfrom % of charges | $450 | $1.2k | $1.1k | 93% | — | $121 – $3.0k |
| 18 | Cigna ppo percent of total billed charges · outpatientfrom % of charges | $452 | $1.2k | $1.1k | 93% | — | $121 – $3.0k |
| 19 | Aetna asa percent of total billed charges · outpatientfrom % of charges | $454 | $1.2k | $1.1k | 93% | — | $122 – $3.0k |
| 20 | Aetna coventry percent of total billed charges · outpatientfrom % of charges | $454 | $1.2k | $1.1k | 93% | — | $122 – $3.0k |
| 21 | Phcs ppo percent of total billed charges · inpatientfrom % of charges | $483 | $1.3k | $1.2k | 93% | — | $130 – $3.2k |
| 22 | MultiPlan commercial percent of total billed charges · inpatientfrom % of charges | $564 | $1.5k | $1.4k | 93% | — | $152 – $3.8k |
| 23 | MultiPlan commercial percent of total billed charges · outpatientfrom % of charges | $564 | $1.5k | $1.4k | 93% | — | $152 – $3.8k |
| 24 | Cigna indemnity percent of total billed charges · inpatientfrom % of charges | $610 | $1.6k | $1.5k | 93% | — | $164 – $4.1k |
| 25 | Cigna indemnity percent of total billed charges · outpatientfrom % of charges | $610 | $1.6k | $1.5k | 93% | — | $164 – $4.1k |
Last updated: Apr 21, 2026
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