CMS Price Transparency Data

Diagnostic mammogram (both breasts)

Facility: Major Hospital

Billing Code: 77066 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77066
Insurance Median: $437
Cash Discount Price: $208
vs. Medicare Baseline: 2.78x Medicare

The contracted insurance negotiated median rate for a Diagnostic mammogram (both breasts) at Major Hospital is $437. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $208. Compared to the federal Medicare reimbursement reference rate of $156.98, this hospital’s rate is 2.78x the Medicare baseline. Located in 2451 Intelliplex Dr, Shelbyville, IN.

Cash / Self-Pay

$208

Average discount available for prompt cash payment at this facility.

Insurance Median

$437

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$156.98

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $156.98 (100%)

Cash / Self-Pay: $208 (133%)

Insurance Median: $437 (278%)

Cash: $208 (133% of Medicare)

Ins. Median: $437 (278% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $156.98 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 278% of the Medicare baseline (a markup of 178%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$84 - $330	54%
Caresource Mrktplce -All Plans	$279	178%
Ambetter / Centene	$293	187%
Sho Direct-All Plans	$370	236%
UnitedHealthcare	$425 - $437	271%
Phcs - All Plans	$510	325%
Aetna	$564	359%
Siho-All Plans	$584	372%
Humana	$605	385%
First Health - All Plans	$631	402%
Cigna	$664	423%

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 $208.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 77066.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Major Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 77066.
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.