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Virginia rates for HCPCS J0476

Injection, baclofen, 50 mcg for intrathecal trial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.95 / $77.05 / $153.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $52.45 / $52.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.84 / $71.51 / $107.92
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.46 / $59.94 / $69.12
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.22 / $49.95 / $89.94
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.00 / $90.00 / $90.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.21 / $47.45 / $63.94
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.21 / $47.45 / $63.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.45 / $49.95 / $62.69