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Wisconsin rates for HCPCS J3475

Injection Magnesium Sulfate Per 500 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.28 / $55.78 / $130.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $1.10 / $4.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $1.15 / $1.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $1.08 / $1.23
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.50 / $0.71
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.96 / $0.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $12.84 / $27.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.50 / $0.71
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.96 / $0.96
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.74 / $2.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.48 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.67 / $0.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.72