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Vermont rates for HCPCS J0476

Injection Baclofen 50 Mcg For Intrathecal Trial (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $115.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.55 / $56.55 / $56.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.12 / $60.93 / $101.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $49.95
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.12 / $60.93 / $101.55
MVP Health Care
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 / $58.75