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Maryland 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 / $99.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $90.05
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $67.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $63.62
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $62.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $69.12
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.72 / $40.72 / $40.72