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Arkansas rates for HCPCS J0476

Injection Baclofen 50 Mcg For Intrathecal Trial (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.94 / $77.28 / $80.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $59.94 / $80.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.91 / $72.91 / $72.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.85 / $72.91 / $72.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.12 / $49.95 / $59.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $62.33