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Washington rates for HCPCS J3475

Injection, magnesium sulfate, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.61 / $12.16 / $125.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.61 / $4.28
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.50 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.52 / $0.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.59
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.60 / $1.50
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.52
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.53 / $0.60
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Regence BlueShield
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 / $0.57