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Texas rates for HCPCS J3475

Injection, magnesium sulfate, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.72 / $25.89 / $144.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.49 / $0.68
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.14 / $0.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.17
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.67 / $86.40
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.46 / $17.46 / $17.46
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.49 / $8.32 / $34.20
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.48 / $0.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.48 / $0.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.48 / $0.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.65