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Montana rates for HCPCS J3475

Injection, magnesium sulfate, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.32 / $57.84 / $225.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.61 / $3.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.56 / $1.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.56 / $1.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.52 / $0.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48