What information is available on CompareMaine?

Users can compare the average payments for over 300 common healthcare procedures performed at more than 200 healthcare settings in Maine, including hospitals. The information used to calculate the average payments come from the Maine Health Data Organization’s All-Payer Claims Database (APCD) and represents claims data that commercial payors are required to submit to the Maine Health Data Organization (MHDO) as defined in 90-590 CMR Chapter 243, Uniform Reporting System for Health Care Claims Data Sets.

The commercial payment data represents the reporting period July 1, 2023 – June 30, 2024. CompareMaine does not include information on Medicare Advantage, public payors (Medicare and MaineCare), or the uninsured. A total of 1,879,255 healthcare claims from 16 commercial payors, including claims from self-insured ERISA plans that voluntarily submit data to MHDO, were analyzed in the development of the payment estimates.

Why can I only search for five payors on CompareMaine when more are included in the data?

MHDO requires a certain volume of claims data for each procedure to be eligible for reporting on CompareMaine. The top five commercial payors on CompareMaine represent approximately 91% of the claims data that is used to generate payment estimates on CompareMaine:

• Aetna (includes Aetna Health Inc. and Aetna Life Insurance Company)
• Anthem (includes Anthem Health Plans of Maine, Inc. and Anthem Insurance Companies, Inc.)
• CIGNA (includes CIGNA Health & Life Insurance Company)
• Community Health Options
• Harvard Pilgrim (includes HPHC Insurance Company Inc and Harvard Pilgrim Health Care Inc)

Commercial payors with insufficient volume are not identified independently on CompareMaine but their payment data is included in the statewide average payments.

Are the payments reported on CompareMaine the price I will pay?

No. The payments on CompareMaine represent average (median) payments and are meant to serve as a reference point for comparison and discussion. Please contact your insurance company to find out your actual out-of-pocket costs. If you do not have insurance, please contact the healthcare setting that you are interested in to discuss the cash price.

How do I know if I’m looking up the correct service or procedure?

Services and procedures on CompareMaine are identified by choosing a topic and searching for either a procedure name, keyword, or CPT Code. A CPT Code is a five-digit code used in healthcare to identify healthcare services and procedures. CPT Codes distinguish procedures from one another, such as a CT of abdomen with dye (CPT Code 74160) and a CT of abdomen without dye (CPT Code 74150). You can ask your provider for the CPT Code for the services or procedure(s) you are looking for on CompareMaine. The information provided on CompareMaine is intended to support conversations that you have with your providers. There may be additional services or procedures that you receive along with a given procedure that can change the amount of the average payment.

CompareMaine reports average payment amount. What does this mean?

CompareMaine reports the average payment to the provider for a service or procedure based on the claims data submitted by commercial payors (excludes data from the public payors Medicare and Medicaid) to the MHDO’s APCD. The average payment is calculated using the median, the middle number of a range of numbers ordered from lowest to highest. The average payment represents the amount paid by the commercial payor and the patient’s out-of-pocket payments. Your individual out-of-pocket payments depend on the type of health insurance coverage you have. In the Resources section, you will find links to several Health Insurance Cost Calculators; these tools take your specific plan into account, including your deductibles and co-insurance, and provide more accurate estimates of member out-of-pocket costs.

Why does the average payment for the same procedure differ from one provider to another?

National research conducted over the years shows there is geographic variation in the cost of healthcare across the country and in the State of Maine. There are many reasons for these variations in payments, including access to providers, supply and demand, and health status of the population. The primary reasons for CompareMaine are to promote transparency on the average amount paid for common healthcare procedures at different healthcare settings in Maine, the quality of care at hospitals, and how they vary.

How does this information help me make better decisions?

CompareMaine reflects the average payments for common healthcare services and procedures by healthcare setting and how those payments differ around the state. This information gives you a starting point to begin conversations with healthcare providers and/or insurance companies. Please contact your insurance company to find your actual out-of-pocket expenses.

Is this website useful to individuals without health insurance?

Yes, it can be. CompareMaine does not include information on the average payment in Maine for a healthcare procedure without insurance, but you can use this website as a reference for the average payments in Maine with insurance.

A provision in the federal legislation, the Affordable Care Act, addresses what hospitals may charge individuals eligible for financial assistance for emergency and medically necessary care: “Section 501I(5) requires a hospital organization to limit amounts charged for emergency or other medically necessary care that is provided to individuals eligible for assistance under the organization’s financial assistance policy to not more than the amounts generally billed to individuals who have insurance covering such care.”

Based on Federal Price Transparency Requirement, the Maine Health Data Association provides a list of Maine hospitals and links to their machine-readable files containing a list of all standard charges for all items and services, and consumer-friendly list of standard charges (cash prices) for a limited set of shoppable services. Visit the MHDO website to view a list of Maine hospitals and links to their cash prices.

Please contact the healthcare setting you are interested in to discuss the cash price.

Do imaging payments include both the technical and professional components?

Depending on the healthcare setting and the procedure, the total payment can include multiple components:

• Technical Component – The portion of the payment that covers expenses associated with items like the use of the facility, equipment, supplies, and non-physical medical staff. The technical component may also be referred to as a facility fee.
• Professional Component – The portion of the payment that covers expenses associated with the services provided by physicians, suppliers, and non-institutional providers. The professional component may also be referred to as a professional fee.

To facilitate comparisons, we include both components in the payment estimate. For example, if a healthcare setting only provides the technical component, we find the corresponding claim for the professional component of the imaging service in the data to derive the total payment.

Do blood laboratory services include payments for the blood draw?

Yes. The median payment for labs includes the costs to take (for example, blood draw codes) and transport the sample, when applicable.

I'm having trouble understanding the information on the site. Who should I contact?

Please do not hesitate to contact MHDO with any questions.

How can I provide feedback on the site?

We appreciate your feedback, so please take a few minutes to complete the survey and tell us what you think.