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Maine rates for HCPCS 95811

Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$132.00 / $132.00 / $132.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.97 / $777.87 / $1,115.74
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$123.20 / $132.01 / $188.10
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$323.27 / $336.16 / $392.16
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$534.96 / $654.21 / $927.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$637.23 / $779.05 / $1,205.63
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$117.09 / $149.91 / $229.54
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$520.13 / $629.14 / $962.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.38 / $1,026.43 / $1,801.92
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$150.34 / $207.91 / $338.97
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$618.17 / $839.25 / $1,462.95
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.23 / $852.63 / $1,441.27
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$126.84 / $156.68 / $264.85
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$563.40 / $695.96 / $1,176.44
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.97 / $777.87 / $1,115.74
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$123.20 / $133.52 / $185.73
Martin's Point
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$323.27 / $333.49 / $392.16
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$534.96 / $639.25 / $927.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.29 / $921.77 / $1,380.68
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$162.19 / $187.82 / $243.56
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$571.30 / $734.61 / $1,128.74