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Maine rates for HCPCS 95873

Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.73 / $79.79 / $81.64
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.36 / $21.08 / $24.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.12 / $94.27 / $134.16
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.12 / $24.61 / $36.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.73 / $108.75 / $170.16
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.01 / $30.69 / $42.59
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.09 / $97.29 / $149.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.50 / $27.19 / $41.71
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.15 / $76.88 / $122.73
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.79 / $21.08 / $30.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.52 / $98.44 / $130.03
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$18.00 / $27.61 / $36.97