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Minnesota rates for HCPCS J0476

Injection, baclofen, 50 mcg for intrathecal trial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.95 / $49.95 / $134.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $134.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $59.70 / $124.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.37 / $126.25 / $153.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.85 / $55.37 / $69.63
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.28 / $115.21 / $144.60
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.28 / $54.83 / $74.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.20 / $92.44 / $113.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.20 / $67.20 / $120.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $89.91