CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Mainehealth Pen Bay Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $163
Cash Discount Price: $144
vs. Medicare Baseline: 1.71x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Mainehealth Pen Bay Hospital is $163. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $144. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.71x the Medicare baseline. Located in 6 Glen Cove Drive, Rockport, ME.

Cash / Self-Pay

$144

Average discount available for prompt cash payment at this facility.

Insurance Median

$163

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $144 (151%)

Insurance Median: $163 (171%)

Cash: $144 (151% of Medicare)

Ins. Median: $163 (171% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Cross Blue Shield	$63 - $606	66%
Aetna	$64 - $309	67%
Wellcare	$65 - $128	68%
Humana	$72 - $125	76%
UnitedHealthcare	$72 - $329	76%
Cigna	$104 - $278	109%
Community Health Options	$105 - $280	110%
Harvard Pilgrim Healthcare	$107 - $300	112%
Multiplan	$122 - $332	128%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $144.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mainehealth Pen Bay Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99213.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.