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Arizona rates for HCPCS J0476

Injection, baclofen, 50 mcg for intrathecal trial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.45 / $99.90 / $149.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $81.31 / $134.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.45 / $185.21 / $307.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.72 / $65.05 / $317.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.20 / $81.31 / $105.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.20 / $67.20 / $67.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95