What information is available on CompareMaine?

Users can compare the average payments for 320 procedures at 344 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 health insurance 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 April 1, 2022– March 31, 2023. CompareMaine does not include information on the uninsured or public payors (Medicare and MaineCare). A total of 9,876,343 healthcare claims from 28 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 5 specific payors that are identified on CompareMaine represent approximately 80% of the claims data that is used to generate the estimates on CompareMaine. The smaller payors do not have the required volume and therefore are not identified independently but instead their payment data is included in the statewide average payment estimates.

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. 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 what you be asked to pay. When contacted directly, healthcare settings often communicate what they charge for a healthcare service or procedure, which is often higher than the actual payments they receive from the contractual arrangements negotiated with insurance companies and from individuals without insurance.

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

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.

What information will be available in later releases of the CompareMaine website?

Future releases of CompareMaine will include updated payment estimates and enhancements to our methodology, such as how we identify healthcare settings and procedures and how average payments are calculated.

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 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 insurance company 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?

Research conducted over the years shows that there is geographic variation in the cost of healthcare. A healthcare provider or setting in Maine will bill for the exact same services and procedures, but the payments can vary widely across the State. One of the primary reasons for CompareMaine is to equip people with information about average payments, how they vary, and potential alternative options.

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.”

Please contact the healthcare setting you are interested in to discuss what you may be asked to pay.

Do imaging payments include both the facility and professional fees?

Yes. There are healthcare settings that provide both the facility and professional components of an imaging procedure while other healthcare settings only provide one component. To facilitate comparisons, we include both components in the payment estimate. For example, if a healthcare setting only provides the facility 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.