CMS Price Transparency Data

C-section delivery (full package)

Facility: Down East Community Hospital

Billing Code: 59510 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 59510
Insurance Median: $10,465
Cash Discount Price: $15,590
vs. Medicare Baseline: 4.23x Medicare

The contracted insurance negotiated median rate for a C-section delivery (full package) at Down East Community Hospital is $10,465. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15,590. Compared to the federal Medicare reimbursement reference rate of $2,473.27, this hospital’s rate is 4.23x the Medicare baseline. Located in 11 Hospital Drive, Machias, ME.

Cash / Self-Pay

$15,590

Average discount available for prompt cash payment at this facility.

Insurance Median

$10,465

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$2,473.27

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $2,473.27 (100%)

Cash / Self-Pay: $15,590 (630%)

Insurance Median: $10,465 (423%)

Cash: $15,590 (630% of Medicare)

Ins. Median: $10,465 (423% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $2,473.27 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 423% of the Medicare baseline (a markup of 323%). 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
Blue Cross Blue Shield	$2,443 - $29,069	99%
Humana	$2,443 - $15,849	99%
Wellcare	$2,443 - $15,849	99%
Partners Direct Health	$2,776 - $18,011	112%
Community Health Options	$4,597 - $29,825	186%
Aetna	$4,636 - $30,078	187%
UnitedHealthcare	$4,775 - $30,978	193%
Martins Point	$4,997 - $32,419	202%
Patients Advocates	$4,997 - $32,419	202%
Cigna	$5,008 - $32,491	202%
Harvard Pilgrim	$5,080 - $32,959	205%

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 $15,590.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 59510.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Down East Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 59510.
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.