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Montana rates for HCPCS J0475

Injection, baclofen, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $181.97 / $1,174.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $75,857.76 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $199.53 / $512.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $181.97 / $199.53
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $190.55 / $537.03
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $190.55 / $537.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $199.53 / $512.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $177.83 / $257.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $181.97 / $181.97