go back

Wisconsin rates for HCPCS J3475

Injection, magnesium sulfate, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.92 / $83.18 / $141.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $4.27 / $10.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.51 / $0.51 / $0.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.52
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $0.68 / $0.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $1.00 / $1.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.52 / $0.76
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.71
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.95 / $0.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.82 / $14.13 / $30.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $64.57 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.43 / $1.07
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.41 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.58 / $0.58 / $0.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.62