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Alaska rates for HCPCS J0476

Injection, baclofen, 50 mcg for intrathecal trial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.08 / $123.75 / $437.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.88 / $92.91 / $156.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.86 / $132.86 / $132.86
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $160.84
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.38 / $61.47 / $87.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.38 / $79.12 / $132.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $54.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $74.93 / $100.76