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
Sugammadex Sodium 500 MG/5ML Soln 5 mL Vial
Lewistown, PA
See all hospitals reporting HCPCS J3490 →Price type
Geisinger Lewistown Hospital’s median price of $143 is 196% above the median hospital's median price ($48), higher than 78% 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: 6 payers, 15 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 | Medicaid medicaid fee schedule · outpatient | $1.00 | $1.00 | $1.00 – $1.00 |
| 2 | UnitedHealthcare united healthcare - managed medicaid fee schedule · outpatient | $1.47 | $1.47 | $1.47 – $1.47 |
| 3 | UnitedHealthcare united healthcare - chip - managed medicare fee schedule · outpatient | $2.50 | $2.50 | $2.50 – $2.50 |
| 4 | Blue Cross Blue Shield capital - special network rates percent of total billed charges · outpatientfrom % of charges | $109.99 | $410.08 | $49.39 – $1,831 |
| 5 | Aetna aetna percent of total billed charges · outpatientfrom % of charges | $139.31 | $519.41 | $62.56 – $2,320 |
| 6 | Cigna cigna percent of total billed charges · outpatientfrom % of charges | $140.45 | $523.66 | $63.07 – $2,339 |
| 7 | Blue Cross Blue Shield capital - enhanced network rates percent of total billed charges · outpatientfrom % of charges | $157.12 | $585.83 | $70.56 – $2,616 |
| 8 | Aetna first health network percent of total billed charges · inpatientfrom % of charges | $162.47 | $605.76 | $72.96 – $2,705 |
| 9 | Aetna first health network percent of total billed charges · outpatientfrom % of charges | $162.47 | $605.76 | $72.96 – $2,705 |
| 10 | Blue Cross Blue Shield capital - basic network rates percent of total billed charges · outpatientfrom % of charges | $177.36 | $661.28 | $79.65 – $2,953 |
| 11 | MultiPlan multiplan/private health care system percent of total billed charges · inpatientfrom % of charges | $302.84 | $1,129 | $136.00 – $5,043 |
| 12 | MultiPlan multiplan/private health care system percent of total billed charges · outpatientfrom % of charges | $302.84 | $1,129 | $136.00 – $5,043 |
| 13 | Cigna cigna case rate · inpatient | $16,340 | $16,340 | $16,340 – $16,340 |
| 14 | Blue Cross Blue Shield highmark bc/bs - special care case rate · inpatient | $17,050 | $17,050 | $17,050 – $17,050 |
| 15 | Blue Cross Blue Shield highmark bc/bs case rate · inpatient | $24,358 | $24,358 | $24,358 – $24,358 |
Last updated: Jul 1, 2026
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