CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Lincolnhealth

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $374
Cash Discount Price: $421
vs. Medicare Baseline: 3.93x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Lincolnhealth is $374. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $421. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 3.93x the Medicare baseline. Located in 35 Miles Street, Damariscotta, ME.

Cash / Self-Pay

$421

Average discount available for prompt cash payment at this facility.

Insurance Median

$374

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: $421 (442%)

Insurance Median: $374 (393%)

Cash: $421 (442% of Medicare)

Ins. Median: $374 (393% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 393% of the Medicare baseline (a markup of 293%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Aetna	$64 - $400	67%
Blue Cross Blue Shield	$70 - $771	74%
UnitedHealthcare	$70 - $415	74%
Wellcare	$73 - $174	77%
Humana	$74 - $168	78%
Multiplan	$119 - $415	125%
Community Health Options	$134 - $407	141%
Cigna	$163 - $401	171%
Harvard Pilgrim Healthcare	$175 - $415	184%

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 $421.
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 Lincolnhealth 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.