CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Alice Peck Day Memorial Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $709
Cash Discount Price: $494
vs. Medicare Baseline: 5.62x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Alice Peck Day Memorial Hospital is $709. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $494. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 5.62x the Medicare baseline. Located in 10 Alice Peck Day Drive, Lebanon, NH.

Cash / Self-Pay

$494

Average discount available for prompt cash payment at this facility.

Insurance Median

$709

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: $494 (391%)

Insurance Median: $709 (562%)

Cash: $494 (391% of Medicare)

Ins. Median: $709 (562% 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 562% of the Medicare baseline (a markup of 462%). 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
UnitedHealthcare	$93 - $143	74%
Medicaid / KanCare	$421	333%
Blue Cross Blue Shield	$453 - $816	359%
Harvard Pilgrim	$570 - $795	451%
Tufts	$672	532%
Cigna	$702 - $750	556%
Commercial Generic	$702	556%
Connecticut General	$702	556%
Klais	$709	562%
Wellpoint	$733	581%
Aetna	$825	653%
Mvp	$834	661%
Coventry Health	$871	690%
Coventry Health Wc	$871	690%
Humana	$954	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 $494.
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 Alice Peck Day 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.