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Maine rates for HCPCS 0102T

Extracorporeal shock wave performed by a physician, requiring anesthesia other than local, and involving the lateral humeral epicondyle

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $295.12 / $436.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $489.78 / $588.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $457.09 / $870.96
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $295.12 / $436.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $380.19 / $616.60