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Indiana 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
$50.45 / $104.52 / $305.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $50.45 / $67.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.45 / $99.90 / $149.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.45 / $49.95 / $70.92
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.95 / $49.95 / $74.93
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $62.44
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 / $119.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $69.12