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 5 % TOPICAL OINT [12306]
Arlington, TX
See all hospitals reporting HCPCS J3490 →Price type
AMH Cath Labs LLC’s median price of $342 is 609% above the median hospital's median price ($48), higher than 90% of the 1,749 hospitals reporting HCPCS J3490. 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 managed medicaid percent of total billed charges · outpatientfrom % of charges | $65.95 | $254.89 | $0.45 – $11,382 |
| 2 | UnitedHealthcare managed medicaid percent of total billed charges · outpatientfrom % of charges | $65.95 | $254.89 | $0.45 – $11,382 |
| 3 | WellCare managed medicaid percent of total billed charges · outpatientfrom % of charges | $69.28 | $267.77 | $0.47 – $11,957 |
| 4 | Molina managed medicaid percent of total billed charges · outpatientfrom % of charges | $71.21 | $275.22 | $0.48 – $12,290 |
| 5 | Aetna managed medicaid percent of total billed charges · outpatientfrom % of charges | $72.54 | $280.37 | $0.49 – $12,520 |
| 6 | Blue Cross Blue Shield exchange percent of total billed charges · outpatientfrom % of charges | $214.88 | $830.53 | $1.45 – $37,086 |
| 7 | Aetna whole health percent of total billed charges · inpatientfrom % of charges | $253.13 | $991.23 | $1.73 – $44,222 |
| 8 | Aetna whole health percent of total billed charges · outpatientfrom % of charges | $304.24 | $1,176 | $2.05 – $52,509 |
| 9 | Aetna commercial percent of total billed charges · inpatientfrom % of charges | $337.45 | $1,321 | $2.31 – $58,954 |
| 10 | Blue Cross Blue Shield hmo percent of total billed charges · outpatientfrom % of charges | $342.32 | $1,323 | $2.31 – $59,082 |
| 11 | Blue Cross Blue Shield ppo percent of total billed charges · outpatientfrom % of charges | $380.85 | $1,472 | $2.57 – $65,732 |
| 12 | UnitedHealthcare all payer percent of total billed charges · outpatientfrom % of charges | $383.22 | $1,481 | $2.59 – $66,141 |
| 13 | Aetna commercial percent of total billed charges · outpatientfrom % of charges | $405.67 | $1,568 | $2.74 – $70,016 |
| 14 | UnitedHealthcare ppo percent of total billed charges · outpatientfrom % of charges | $406.05 | $1,569 | $2.74 – $70,080 |
| 15 | Cigna oap/hmo percent of total billed charges · outpatientfrom % of charges | $409.60 | $1,583 | $2.76 – $70,693 |
| 16 | Phcs ppo percent of total billed charges · outpatientfrom % of charges | $514.96 | $1,990 | $3.48 – $88,878 |
| 17 | Cigna ppo percent of total billed charges · outpatientfrom % of charges | $516.44 | $1,996 | $3.49 – $89,134 |
| 18 | Aetna asa percent of total billed charges · outpatientfrom % of charges | $519.41 | $2,008 | $3.51 – $89,646 |
| 19 | Aetna coventry percent of total billed charges · outpatientfrom % of charges | $519.41 | $2,008 | $3.51 – $89,646 |
| 20 | Phcs ppo percent of total billed charges · inpatientfrom % of charges | $552.01 | $2,134 | $3.73 – $95,272 |
| 21 | Blue Cross Blue Shield traditional percent of total billed charges · outpatientfrom % of charges | $611.29 | $2,363 | $4.13 – $105,503 |
| 22 | MultiPlan commercial percent of total billed charges · inpatientfrom % of charges | $644.63 | $2,492 | $4.35 – $111,258 |
| 23 | MultiPlan commercial percent of total billed charges · outpatientfrom % of charges | $644.63 | $2,492 | $4.35 – $111,258 |
| 24 | Cigna indemnity percent of total billed charges · inpatientfrom % of charges | $697.24 | $2,695 | $4.71 – $120,337 |
| 25 | Cigna indemnity percent of total billed charges · outpatientfrom % of charges | $697.24 | $2,695 | $4.71 – $120,337 |
Last updated: Apr 21, 2026
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