CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Down East Community Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $111
Cash Discount Price: $116
vs. Medicare Baseline: 1.17x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Down East Community Hospital is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $116. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.17x the Medicare baseline. Located in 11 Hospital Drive, Machias, ME.

Cash / Self-Pay

$116

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $116 (122%)

Insurance Median: $111 (117%)

Cash: $116 (122% of Medicare)

Ins. Median: $111 (117% 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	$46 - $163	48%
Humana	$46 - $89	48%
Wellcare	$46 - $89	48%
Partners Direct Health	$53 - $101	56%
Community Health Options	$87 - $167	91%
Aetna	$88 - $169	92%
UnitedHealthcare	$90 - $174	95%
Cigna	$95 - $182	100%
Martins Point	$95 - $182	100%
Patients Advocates	$95 - $182	100%
Harvard Pilgrim	$96 - $185	101%

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 $116.
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 Down East Community 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.