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South Carolina 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
$52.45 / $218.40 / $256.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.45 / $61.49 / $108.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.51 / $126.08 / $221.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.56 / $47.47 / $68.31
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 / $49.95
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.56 / $57.70 / $110.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95