CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Penobscot Valley Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $96
Cash Discount Price: $142
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Penobscot Valley Hospital is $96. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $142. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.01x the Medicare baseline. Located in 7 Transalpine Road, Po Box 368, Lincoln, ME.

Cash / Self-Pay

$142

Average discount available for prompt cash payment at this facility.

Insurance Median

$96

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: $142 (149%)

Insurance Median: $96 (101%)

Cash: $142 (149% of Medicare)

Ins. Median: $96 (101% 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
Medicare (plans)	$13 - $200	14%
UnitedHealthcare	$13 - $204	14%
Aetna	$14 - $417	15%
Blue Cross Blue Shield	$14 - $322	15%
Humana	$14 - $102	15%
Wellcare Health Plan Inc Mcr Adv	$14 - $95	15%
Cigna	$27 - $408	28%
Harvard Pilgrim Healthcare	$28 - $415	29%

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 $142.
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 Penobscot Valley 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.