Commercial healthcare reimbursement in Maine
How Maine compares with the nation, by payer, specialty and procedure.
Maine at a glance
What the data shows
Maine ranks 23rd of 51 states for commercial reimbursement, with an index of 100 (100 = national median) across 228 procedure codes; the Northeast region averages 107.
Commercial rates in Maine run a median 148% of Medicare.
UnitedHealthcare has the highest index in the state (124) and Aetna the lowest (85), a 39-point gap, in the files analyzed.
CPT 93297 (Rem interrog dev eval icpms) is the strongest relative to the national median (175% of it, a 75% premium); CPT 52000 (Cystourethroscopy) is furthest below (72% of the national median, 28% lower).
By specialty, Maine is strongest for dermatology (ranks 14th of 50 states for that specialty) and weakest for urology (36th of 50).
Against Medicare, gastroenterology has the highest ratio in Maine (171% of Medicare) and internal medicine the lowest (121%).
Payer ranking in Maine
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 124 | 1 | 228 | 546 | 278 | |
| Blue Cross Blue Shield | 103 | 2 | 159 | 215 | 304 | |
| Cigna | 100 | 3 | 227 | 597 | 324 | |
| Aetna | 85 | 4 | 223 | 552 | 342 |
Reimbursement index by specialty in Maine
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Dermatology | 134 | 14 of 50 | 133% | 44 | 41 | |
| Ophthalmology | 113 | 18 of 50 | 134% | 42 | 64 | |
| Diagnostic radiology | 103 | 19 of 51 | 151% | 49 | 127 | |
| Internal medicine | 107 | 20 of 51 | 121% | 25 | 120 | |
| Cardiology | 97 | 30 of 51 | 146% | 38 | 100 | |
| Gastroenterology | 95 | 31 of 50 | 171% | 36 | 53 | |
| Orthopedic surgery | 95 | 31 of 51 | 126% | 39 | 94 | |
| Urology | 91 | 36 of 50 | 152% | 37 | 48 |
Specialty by payer in Maine
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 157 | 71 | 117 | 100 |
| Dermatology | 210 | 86 | 133 | n/a |
| Ophthalmology | 133 | 100 | 112 | n/a |
| Cardiology | 118 | 74 | 101 | 114 |
| Orthopedic surgery | 106 | 78 | 95 | 89 |
| Diagnostic radiology | 126 | 98 | 109 | 107 |
| Urology | 137 | 75 | 102 | 93 |
| Gastroenterology | 129 | 74 | 102 | 100 |
Maine compared with Northeast region states
| State | Index | Rank | % of Medicare | Providers | Level |
|---|---|---|---|---|---|
| Maine | 100 | 23 | 148% | 647 | |
| New Jersey | 100 | 22 | 154% | 887 | |
| Rhode Island | 99 | 26 | 148% | 632 | |
| Pennsylvania | 96 | 30 | 143% | 892 | |
| Vermont | 107 | 18 | 157% | 365 | |
| New York | 93 | 37 | 132% | 942 |
Procedures that pay most and least in Maine vs the nation
Highest vs national
| Code | Maine | National | Gap | Prov. |
|---|---|---|---|---|
| 93297 Rem interrog dev eval icpms | $92 | $52 | +75% | 98 |
| 17110 Destruction b9 les up to 14 | $148 | $101 | +46% | 41 |
| 17261 Dstrj mal les t/a/l .6-1.0cm | $192 | $132 | +45% | 41 |
| 11602 Exc tr-ext mal+marg 1.1-2 cm | $330 | $228 | +45% | 41 |
| 17111 Destruction b9 lesions 15/> | $173 | $120 | +44% | 41 |
| 17282 Dstr mal ls f/e/e/n/l/m1.1-2 | $280 | $195 | +44% | 41 |
| 99202 Office o/p new sf 15 min | $97 | $70 | +40% | 41 |
| 12052 Intmd rpr face/mm 2.6-5.0 cm | $403 | $289 | +39% | 41 |
| 11301 Shave skin lesion 0.6-1.0 cm | $118 | $85 | +39% | 41 |
| 11603 Exc tr-ext mal+marg 2.1-3 cm | $371 | $267 | +39% | 41 |
| 12042 Intmd rpr n-hf/genit2.6-7.5 | $396 | $285 | +39% | 41 |
| 17313 Mohs 1 stage t/a/l | $713 | $515 | +38% | 41 |
| 17311 Mohs 1 stage h/n/hf/g | $794 | $577 | +38% | 41 |
| 11104 Punch bx skin single lesion | $110 | $81 | +36% | 41 |
| 13121 Cmplx rpr s/a/l 2.6-7.5 cm | $538 | $398 | +35% | 41 |
Lowest vs national
| Code | Maine | National | Gap | Prov. |
|---|---|---|---|---|
| 52000 Cystourethroscopy | $151 | $210 | -28% | 48 |
| 51700 Irrigation of bladder | $56 | $77 | -27% | 48 |
| 43239 Egd biopsy single/multiple | $260 | $349 | -26% | 53 |
| 51720 Treatment of bladder lesion | $84 | $111 | -24% | 48 |
| 51702 Insert temp bladder cath | $47 | $61 | -23% | 48 |
| 43235 Egd diagnostic brush wash | $231 | $294 | -21% | 53 |
| 43255 Egd control bleeding any | $365 | $459 | -20% | 53 |
| 45380 Colonoscopy and biopsy | $377 | $470 | -20% | 53 |
| 43248 Egd guide wire insertion | $294 | $364 | -19% | 53 |
| 64566 Neuroeltrd stim post tibial | $56 | $69 | -19% | 48 |
| 52332 Cystoscopy and treatment | $294 | $360 | -18% | 48 |
| 43251 Egd remove lesion snare | $348 | $425 | -18% | 53 |
| 52224 Cystoscopy and treatment | $379 | $459 | -17% | 48 |
| 45378 Diagnostic colonoscopy | $337 | $408 | -17% | 53 |
| 27447 Total knee arthroplasty | $1,846 | $2,190 | -16% | 93 |
Frequently asked questions
How do commercial reimbursement rates in Maine compare with the rest of the country?
Maine ranks 23rd of 51 states with an index of 100, across 228 procedure codes. Median commercial rates run 148% of the Medicare rate.
Which payer has the highest rates in Maine?
In the files we analyzed, UnitedHealthcare has the highest index (124) and Aetna the lowest (85). Each payer's figures describe the specific plans and networks in the files used, not its whole book of business.
Which specialty has the strongest rates in Maine?
Dermatology ranks 14th of 50 states.
How many providers does this Maine page cover?
647 sampled providers across 4 payers. The data comes from a random sample of providers, so counts describe the sample, not every provider in the state.
Which procedures differ most between Maine and the national median?
CPT 93297 (Rem interrog dev eval icpms) is highest relative to the nation at 175% of the national median; CPT 52000 (Cystourethroscopy) is lowest at 72%.
Methodology
- Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
- Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
- Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
- Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
- Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
- Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.
Benchmark your Maine contracts
Compare your negotiated rates with these state medians by payer and specialty.