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Illinois rates for HCPCS J0476

Injection, baclofen, 50 mcg for intrathecal trial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $100.00 / $154.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $58.88 / $104.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $229.09 / $616.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $58.88 / $58.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $58.88 / $58.88
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $120.23 / $245.47
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $89.13 / $89.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $58.88 / $61.66