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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
$54.45 / $81.31 / $134.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.16 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.43 / $61.43 / $164.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $61.43
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.43 / $61.43 / $164.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $54.19 / $70.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95