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
Cl-depo Provera Vial 150 Mg/ml
Knox City, TX
See all hospitals reporting HCPCS J3490 →Price type
Knox County Hospital District’s median price of $18 is 63% below the median hospital's median price ($48), higher than 24% 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: 5 payers, 7 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 | Bcbs Tx blue advantage hmo percent of total billed charges · outpatientfrom % of charges | $16.00 | $102.14 | $3.00 – $351.00 |
| 2 | Humana commercial fee schedule · outpatient | $18.00 | $115.71 | $4.00 – $397.00 |
| 3 | MultiPlan commercial fee schedule · outpatient | $18.00 | $115.71 | $4.00 – $397.00 |
| 4 | Superior Healthplan commercial fee schedule · outpatient | $18.00 | $115.71 | $4.00 – $397.00 |
| 5 | Bcbs Tx blue essentials percent of total billed charges · outpatientfrom % of charges | $20.00 | $128.71 | $4.00 – $442.00 |
| 6 | Bcbs Tx ppo percent of total billed charges · outpatientfrom % of charges | $20.00 | $128.71 | $4.00 – $442.00 |
| 7 | Aetna commercial percent of total billed charges · outpatientfrom % of charges | $23.00 | $151.29 | $5.00 – $520.00 |
Last updated: Dec 24, 2025
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