CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Cheshire Medical Center

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $130
Cash Discount Price: $136
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Cheshire Medical Center is $130. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $136. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 1.03x the Medicare baseline. Located in 580 Court Street, Keene, NH.

Cash / Self-Pay

$136

Average discount available for prompt cash payment at this facility.

Insurance Median

$130

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: $136 (108%)

Insurance Median: $130 (103%)

Cash: $136 (108% of Medicare)

Ins. Median: $130 (103% 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
Amerihealth Caritas Nh	$24 - $104	19%
Wellsense Health Plan	$27 - $137	21%
Granite State Health Plan	$33 - $132	26%
Aetna	$36 - $541	29%
Ambetter / Centene	$38 - $128	30%
Blue Cross Blue Shield	$38 - $628	30%
Cigna	$38 - $533	30%
Martin'S Point Generations Advantage	$38 - $128	30%
Martin'S Point Health Care	$38 - $131	30%
Mvp	$38 - $533	30%
UnitedHealthcare	$38 - $600	30%
Wellcare Health Plans	$38 - $128	30%
Harvard Pilgrim Health Care Of Ne	$42 - $360	33%
Maine Community Health Options	$89 - $356	70%
Mass General Brigham Health Plan	$98 - $791	78%
Tufts Health Plan	$106 - $505	84%
First Health/Hcvm	$168 - $672	133%
Phcs	$178 - $712	141%

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 $136.
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 Cheshire Medical Center 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.