CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Portsmouth Regional Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $401
Cash Discount Price: $792
vs. Medicare Baseline: 3.18x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Portsmouth Regional Hospital is $401. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $792. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 3.18x the Medicare baseline. Located in 333 Borthwick Ave, Portsmouth, NH.

Cash / Self-Pay

$792

Average discount available for prompt cash payment at this facility.

Insurance Median

$401

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: $792 (627%)

Insurance Median: $401 (318%)

Cash: $792 (627% of Medicare)

Ins. Median: $401 (318% 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 318% of the Medicare baseline (a markup of 218%). 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
Amerihealth Caritas	$26 - $39	21%
Well Sense Health Plan	$52 - $78	41%
Humana	$90 - $95	71%
Martin'S Point Health	$91 - $99	72%
Sierra Military Health	$93	74%
Aetna	$95 - $601	75%
United Behavioral Health	$95	75%
United Va Ccn	$95	75%
Blue Cross Blue Shield	$97 - $631	77%
Cigna	$97 - $787	77%
Evernorth Behavioral Health	$97	77%
United	$97 - $627	77%
Ambetter / Centene	$169	134%
Maine Community Health	$198 - $503	157%
Tufts Health Plan	$238 - $543	189%
Harvard Pilgrim	$342 - $428	271%
Mvp Health Plan	$444 - $665	352%
Corvel	$456 - $684	361%
Evernorth	$507 - $760	402%
Mutual Of Omaha	$507 - $760	402%
Multiplan	$514 - $770	407%
First Health	$577 - $864	457%
Healthcare Value Mgmt	$577 - $864	457%
Oxford Health Plans	$602 - $902	477%

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 $792.
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 Portsmouth Regional 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.