CMS Price Transparency Data

Injection procedure for pain management

Facility: Down East Community Hospital

Billing Code: G0260 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0260
Insurance Median: $579
Cash Discount Price: $522
vs. Medicare Baseline: 0.80x Medicare

The contracted insurance negotiated median rate for a Injection procedure for pain management at Down East Community Hospital is $579. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $522. Compared to the federal Medicare reimbursement reference rate of $721.17, this hospital’s rate is 0.80x the Medicare baseline. Located in 11 Hospital Drive, Machias, ME.

Cash / Self-Pay

$522

Average discount available for prompt cash payment at this facility.

Insurance Median

$579

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$721.17

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $721.17 (100%)

Cash / Self-Pay: $522 (72%)

Insurance Median: $579 (80%)

Cash: $522 (72% of Medicare)

Ins. Median: $579 (80% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $721.17 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
Wellcare	$306	42%
Blue Cross Blue Shield	$306 - $562	42%
Humana	$306	42%
Partners Direct Health	$348	48%
Community Health Options	$576	80%
Aetna	$581	81%
UnitedHealthcare	$599	83%
Martins Point	$626	87%
Patients Advocates	$626	87%
Cigna	$628	87%
Harvard Pilgrim	$637	88%

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 $522.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0260.

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 HCPCS code G0260.
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.