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South Carolina rates for HCPCS J0476

Injection, baclofen, 50 mcg for intrathecal trial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $218.78 / $251.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $61.66 / $95.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $134.90 / $239.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $56.23 / $72.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $58.88 / $58.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $58.88 / $58.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $85.11 / $125.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $58.88 / $66.07