CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Mary Hitchcock Memorial Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $198
Cash Discount Price: $196
vs. Medicare Baseline: 1.57x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Mary Hitchcock Memorial Hospital is $198. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $196. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 1.57x the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.

Cash / Self-Pay

$196

Average discount available for prompt cash payment at this facility.

Insurance Median

$198

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: $196 (155%)

Insurance Median: $198 (157%)

Cash: $196 (155% of Medicare)

Ins. Median: $198 (157% 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	$35 - $836	28%
Martin'S Point Generations Advantage	$35 - $128	28%
Mvp	$35 - $643	28%
UnitedHealthcare	$35 - $737	28%
Aetna	$36 - $673	29%
Amerihealth Caritas Nh	$36 - $109	29%
Cigna	$36 - $658	29%
Martin'S Point Health Care	$36 - $331	29%
Wellsense Health Plan	$36 - $134	29%
Ambetter / Centene	$37 - $304	29%
Wellcare Health Plans	$37 - $133	29%
Beacon Health Strategies/Carelon	$39 - $117	31%
Granite State Health Plan	$40 - $121	32%
Harvard Pilgrim Health Care Of Ne	$44 - $687	35%
Mass General Brigham Health Plan	$102 - $596	81%
Tufts Health Plan	$117 - $559	93%
Maine Community Health Options	$204 - $705	162%
Coventry	$279 - $834	221%
First Health/Hcvm	$279 - $834	221%
Phcs	$289 - $863	229%
Corvel	$295 - $882	234%
Ccmsi	$305 - $911	242%

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 $196.
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 Mary Hitchcock Memorial 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.