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Utah rates for HCPCS J3475

Injection, magnesium sulfate, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.76 / $48.80 / $96.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $14.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.71 / $1.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48