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North Carolina rates for HCPCS J0476

Injection, baclofen, 50 mcg for intrathecal trial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.88 / $70.79 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $61.66 / $117.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $204.17 / $229.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $45.71 / $58.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $58.88 / $58.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $58.88 / $58.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $64.57 / $74.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $89.13 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $58.88 / $77.62
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $275.42 / $275.42