CMS Price Transparency Data

Vaginal delivery (full package)

Facility: Down East Community Hospital

Billing Code: 59400 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 59400
Insurance Median: $7,109
Cash Discount Price: $10,388
vs. Medicare Baseline: 3.21x Medicare

The contracted insurance negotiated median rate for a Vaginal delivery (full package) at Down East Community Hospital is $7,109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,388. Compared to the federal Medicare reimbursement reference rate of $2,214.42, this hospital’s rate is 3.21x the Medicare baseline. Located in 11 Hospital Drive, Machias, ME.

Cash / Self-Pay

$10,388

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,109

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$2,214.42

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $2,214.42 (100%)

Cash / Self-Pay: $10,388 (469%)

Insurance Median: $7,109 (321%)

Cash: $10,388 (469% of Medicare)

Ins. Median: $7,109 (321% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $2,214.42 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 321% of the Medicare baseline (a markup of 221%). 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	$1,879 - $18,909	85%
Humana	$1,879 - $10,310	85%
Wellcare	$1,879 - $10,310	85%
Partners Direct Health	$2,136 - $11,716	96%
Community Health Options	$3,536 - $19,401	160%
Aetna	$3,566 - $19,565	161%
UnitedHealthcare	$3,673 - $20,151	166%
Martins Point	$3,844 - $21,088	174%
Patients Advocates	$3,844 - $21,088	174%
Cigna	$3,852 - $21,135	174%
Harvard Pilgrim	$3,908 - $21,439	176%

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 $10,388.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 59400.

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 59400.
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.