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New Mexico rates for HCPCS J0476

Injection, baclofen, 50 mcg for intrathecal trial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.95 / $104.77 / $104.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $63.44 / $134.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.75 / $420.77 / $685.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.92 / $77.92 / $77.92
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.95 / $70.59 / $86.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95