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Louisiana 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 / $69.22 / $148.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $50.45 / $81.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.20 / $59.20 / $88.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.20 / $59.20 / $60.38
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.12 / $47.12 / $49.95
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 / $69.12