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Maine rates for HCPCS J3475

Injection Magnesium Sulfate Per 500 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.11 / $44.82 / $98.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.49 / $0.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.48 / $1.48 / $1.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Community Health Options
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.57
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.11 / $26.29 / $94.97
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.52 / $0.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.48 / $0.72