CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Ira Davenport Memorial Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $401
Cash Discount Price: $564
vs. Medicare Baseline: 3.18x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Ira Davenport Memorial Hospital is $401. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $564. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 3.18x the Medicare baseline. Located in 7571 State Route 54, Bath, NY.

Cash / Self-Pay

$564

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: $564 (447%)

Insurance Median: $401 (318%)

Cash: $564 (447% 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
Empire	$27 - $115	21%
Blue Cross Blue Shield	$119 - $2,071	94%
Humana	$119 - $614	94%
Tricare	$119	94%
Amerihealth Caritas Mcr Adv - All Plans	$120	95%
Fidelis	$181	143%
Fidelis Care - Exchange - All Plans	$310 - $375	246%
Geisinger - All Plans	$328 - $397	260%
Cigna	$351 - $425	278%
Mvp Health Plan - All Plans	$351 - $425	278%
Independent Health - All Plans	$366 - $444	290%
Upmc - All Plans	$389 - $471	308%
Pomco Inc - All Plans	$406 - $491	322%
Aetna	$423 - $609	335%
Emblem Health - All Plans	$496 - $601	393%
UnitedHealthcare	$526 - $717	417%
Martins Point - All Plans	$564 - $683	447%
Emblem/Ghi	$631	500%
Healthnow - All Plans	$1,856 - $2,248	1470%

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 $564.
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 Ira Davenport 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.