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Idaho rates for HCPCS J0476

Injection, baclofen, 50 mcg for intrathecal trial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.20 / $67.20 / $77.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $62.44 / $81.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.12 / $49.95 / $49.95
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
$54.95 / $66.19 / $89.29
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $62.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.55 / $83.55 / $102.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.94 / $59.94 / $62.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $79.92