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Pennsylvania rates for HCPCS J3475

Injection, magnesium sulfate, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.60 / $8.46 / $65.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $1.58 / $4.40
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $71.62 / $153.34
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.53 / $0.53 / $0.53
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.44 / $0.52 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.48 / $0.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $2.89 / $13.91
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $0.63 / $147.22
Independence Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.53 / $0.53 / $0.53
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $9.11 / $72.50
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $1.30 / $4.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.48 / $0.48
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.77
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.88