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South Dakota rates for HCPCS J3475

Injection, magnesium sulfate, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.48 / $177.55 / $490.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.53 / $0.53 / $0.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.53 / $0.85 / $38.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.50 / $0.55
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $0.60 / $1.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.60 / $1.07
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.52 / $0.52 / $0.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.53
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.50