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Michigan 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
$51.45 / $69.22 / $215.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $51.45 / $81.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.74 / $111.23 / $210.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.90 / $2.00 / $2.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $90.88
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.56 / $74.93 / $192.61
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $51.45 / $69.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.44 / $61.89 / $77.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $65.03