CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Wentworth-Douglass Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $706
Cash Discount Price: $674
vs. Medicare Baseline: 5.59x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Wentworth-Douglass Hospital is $706. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $674. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 5.59x the Medicare baseline. Located in 789 Central Ave, Dover, NH.

Cash / Self-Pay

$674

Average discount available for prompt cash payment at this facility.

Insurance Median

$706

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: $674 (534%)

Insurance Median: $706 (559%)

Cash: $674 (534% of Medicare)

Ins. Median: $706 (559% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 559% of the Medicare baseline (a markup of 459%). 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
Wellsense Nh [1050]	$131	104%
Generic Commercial [1009]	$131 - $162	104%
Harvard Pilgrim [120001]	$491 - $817	389%
Mgb Health Plan [150001]	$598 - $706	474%
Cigna	$639	506%
Coventry First Health [1021]	$784	621%
Aetna	$784	621%
UnitedHealthcare	$817 - $869	647%
Harvard Pilgrim Alternate [120002]	$817	647%
PHCS Multiplan [1022]	$955	756%

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 $674.
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 Wentworth-Douglass 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.