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Utah 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
$57.94 / $57.94 / $77.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.94 / $57.94 / $57.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.64 / $61.86 / $76.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.45 / $49.95 / $49.95