CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Fairview Park Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $156
Cash Discount Price: $811
vs. Medicare Baseline: 1.24x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Fairview Park Hospital is $156. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $811. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 1.24x the Medicare baseline. Located in 200 Industrial Boulevard, Dublin, GA.

Cash / Self-Pay

$811

Average discount available for prompt cash payment at this facility.

Insurance Median

$156

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$126.25

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $126.25 (100%)

Cash / Self-Pay: $811 (642%)

Insurance Median: $156 (124%)

Cash: $811 (642% of Medicare)

Ins. Median: $156 (124% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $126.25 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
Blue Cross Blue Shield	$48 - $215	38%
Humana	$77 - $81	61%
Health Net	$79	63%
Devoted Health	$81	64%
Hospice Care Options	$81	64%
Southern Care Birmingham	$81	64%
United	$81 - $365	64%
Aetna	$82 - $447	65%
Healthspring	$82	65%
Coventry	$83	66%
Wellcare	$83 - $162	66%
Clover	$86	68%
Eon Health	$86	68%
Georgia Assurance	$86	68%
Shared Health	$86	68%
Amerigroup	$109	86%
Ambetter / Centene	$118	93%
Ryan White Care Act	$122	97%
Health One Alliance	$142	112%
Nhc Advantage	$154	122%
Pruitt Health	$154	122%
Peach State	$162	128%
Memorial Health Plan	$178 - $365	141%
Core Resources	$192	152%
Centurion	$225	178%
Americas 1St Choice	$227	180%
Leavitt Risk Partners	$243	192%
Dodge County Hospital	$406	322%
American Steel Products	$689	546%
City Of Eastman	$689	546%
Dodge Co Board Of Commissioners	$689	546%
Graham Brothers Construction	$689	546%
Multiplan	$730	578%
Novanet	$730	578%

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 $811.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 77067.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Fairview Park Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 77067.
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.