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Montana rates for HCPCS J0476

Injection, baclofen, 50 mcg for intrathecal trial

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $58.88 / $104.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $46,773.51 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $61.66 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $58.88 / $61.66
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $61.66 / $112.20
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $61.66 / $112.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $61.66 / $165.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $64.57 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $58.88 / $58.88