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North Dakota 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 / $120.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $81.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.19 / $54.46 / $55.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.06 / $54.38 / $54.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.83 / $54.83 / $68.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.22 / $46.92 / $114.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.82 / $67.20 / $72.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.46 / $49.95 / $54.25