Down East Community Hospital
11 Hospital Drive, Machias, ME 04654 · 104 Priced Procedures · 70% Patient Recommendation
Typical commercial prices here match the fair market benchmark (1.00×) after accounting for local nurse/doctor wages and patient complexity.
4-Star CMS clinical quality rating paired with 1.00× fair market pricing.
Aligned Regional Benchmark Peer
Down East Community Hospital prices shoppable and inpatient services (7.5× to 5.6× Medicare, divergence 0.75×) in alignment with regional hospital peers (1.00× Fair BaseRate). Reviewing plan-specific negotiated rates and cash discounts helps lock in the lowest out-of-pocket tier.
Where They're Good (Patient & Payer Edge)
- Bottom-quartile procedures (Q25) price at 0.78× the peer BaseRate benchmark
- Self-pay cash beats commercial insurance on 69% of shoppable procedures (99/100 Cash Honesty)
- 4-Star CMS clinical rating with 70% patient recommendation (66/100 safety score)
- IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (60.4% AGB cap)
Where You Can Get Burned (Markup Traps)
- Outpatient surgery & OR suites carry a 2.3× markup over Medicare rates
- Commercial insurance median sits at 1.00× Fair BaseRate (7.5× Medicare), so insured patients should always compare the self-pay cash price before paying.
- Upper-quartile procedures (Q75 1.28×) jump +28% above the median procedure ratio (Q50 1.00×)
- Unnegotiated chargemaster list prices average 7.8× Medicare (25¢ true HCRIS cost per $1 gross)
Pre-scheduled outpatient procedures where patients can comparison-shop.
Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.
Detects median-gaming when upper-quartile codes spike above the p50 median.
Procedure Prices at Down East Community Hospital
High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 104 published procedures.
| Procedure & Billing Code | This Hospital | vs. Fair |
|---|---|---|
| Hip or knee replacement (inpatient stay) MS-DRG Code: 470 | $47,375 | 2.4× |
| Inguinal hernia repair CPT Code: 49505 | $33,898 | 9.3× |
| Gallbladder removal (laparoscopic) CPT Code: 47562 | $22,783 | 3.7× |
| C-section delivery (full package) CPT Code: 59510 | $15,719 | 5.3× |
| Knee arthroscopy with meniscus repair CPT Code: 29881 | $12,953 | 3.8× |
| Breast lump removal CPT Code: 19120 | $10,889 | 2.8× |
| Vaginal delivery (full package) CPT Code: 59400 | $8,463 | 3.2× |
| Upper endoscopy with biopsy CPT Code: 43239 | $7,715 | 7.8× |
| Colonoscopy with biopsy CPT Code: 45380 | $7,673 | 6.1× |
| Colonoscopy (diagnostic) CPT Code: 45378 | $5,530 | 5.6× |
| Cataract surgery with lens implant CPT Code: 66984 | $4,575 | 1.8× |
| Total knee replacement CPT Code: 27447 | $3,888 | 0.3× |
| Total hip replacement CPT Code: 27130 | $3,711 | 0.3× |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $3,269 | 7.3× |
| MRI, knee or other leg joint CPT Code: 73721 | $1,820 | 4.9× |
| CT scan, abdomen and pelvis (no contrast) CPT Code: 74176 | $1,733 | 5.7× |
| MRI, brain (with and without contrast) CPT Code: 70553 | $1,661 | 3.3× |
| Bunion correction surgery CPT Code: 28296 | $1,447 | 0.4× |
| CT scan, head (with and without contrast) CPT Code: 70470 | $1,235 | 4.8× |
| MRI, lower back (no contrast) CPT Code: 72148 | $1,135 | 3.4× |
| MRI, brain (no contrast) CPT Code: 70551 | $1,135 | 3.3× |
| CT scan, sinuses CPT Code: 70486 | $1,005 | 6.1× |
| CT scan, head (with contrast) CPT Code: 70460 | $999 | 4.1× |
| CT scan, pelvis CPT Code: 72192 | $860 | 5.3× |
| CT scan, chest (no contrast) CPT Code: 71250 | $869 | 5.2× |
Audit a Bill or Quote at Down East Community Hospital (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $38,146
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (60.4% of gross = $38,146).
Self-Pay Cash Rate ($47,375) Beats Your Bill
Down East Community Hospital's published 45 CFR § 180 self-pay cash rate is $47,375 (vs. $47,375 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.
Negotiate Toward $19,432 Fair BaseRate ($14,044 Medicare)
Your bill ($63,166) is $43,734 above the denoised Fair BaseRate ($19,432) and 4.5× the $14,044 Medicare rate.
Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)
Hospital-Specific CMS HCRIS Benchmark (60.4% of gross charges)
Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.
Clinical Quality, Patient Experience & Infection Benchmarks
Source: CMS Hospital Care Compare (93 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.
How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings
2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Down East Community Hospital.
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.