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New Hampshire rates for HCPCS J0476

Injection, baclofen, 50 mcg for intrathecal trial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.20 / $75.26 / $134.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $67.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.72 / $74.93 / $205.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $67.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.12 / $49.95 / $49.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.79 / $83.17 / $154.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.01 / $82.51 / $105.01