CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Lincolnhealth

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $271
Cash Discount Price: $477
vs. Medicare Baseline: 2.00x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Lincolnhealth is $271. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $477. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 2.00x the Medicare baseline. Located in 35 Miles Street, Damariscotta, ME.

Cash / Self-Pay

$477

Average discount available for prompt cash payment at this facility.

Insurance Median

$271

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $477 (352%)

Insurance Median: $271 (200%)

Cash: $477 (352% of Medicare)

Ins. Median: $271 (200% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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
Aetna	$95 - $636	70%
Blue Cross Blue Shield	$103 - $771	76%
UnitedHealthcare	$103 - $660	76%
Wellcare	$107 - $277	79%
Humana	$109 - $267	80%
Multiplan	$175 - $660	129%
Community Health Options	$197 - $647	145%
Cigna	$230 - $637	170%
Harvard Pilgrim Healthcare	$247 - $660	182%

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 $477.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

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 99214.
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.