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Oklahoma rates for HCPCS J0476

Injection Baclofen 50 Mcg For Intrathecal Trial (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.95 / $72.58 / $123.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.95 / $53.95 / $53.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.35 / $96.76 / $153.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.12 / $47.12 / $49.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $73.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.22 / $72.58 / $111.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.82 / $67.20 / $67.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95