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Nebraska rates for HCPCS J0476

Injection, baclofen, 50 mcg for intrathecal trial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.95 / $68.76 / $125.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $67.20 / $134.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.41 / $56.55 / $56.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.71 / $56.54 / $76.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.00 / $61.00 / $61.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $54.83 / $68.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.22 / $127.68 / $273.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.82 / $67.20 / $67.20
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.87 / $71.70 / $95.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.95 / $80.64 / $153.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.45 / $49.95 / $54.95