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Pennsylvania 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
$50.45 / $157.25 / $204.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $50.45 / $134.16
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.06 / $54.19 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.84 / $51.84 / $51.84
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
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.88 / $133.72 / $204.29
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $67.88 / $204.29
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.12 / $49.95 / $49.95
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.70 / $59.70 / $69.27
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.70 / $59.70 / $69.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $70.55