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Maine rates for HCPCS 0647T

Insertion of gastrostomy tube, percutaneous, with magnetic gastropexy, under ultrasound guidance, image documentation and report

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$838.13 / $875.92 / $934.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$959.37 / $1,040.52 / $1,042.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$699.00 / $699.00 / $1,039.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,328.07 / $4,328.07 / $4,328.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,027.95 / $1,323.92 / $2,071.71
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$838.13 / $875.92 / $934.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$909.40 / $1,265.91 / $1,829.61