CMS Price Transparency Data

Diagnostic mammogram (both breasts)

Facility: Adena Pike Medical Center

Billing Code: 77066 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77066
Insurance Median: $565
Cash Discount Price: $375
vs. Medicare Baseline: 3.60x Medicare

The contracted insurance negotiated median rate for a Diagnostic mammogram (both breasts) at Adena Pike Medical Center is $565. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $375. Compared to the federal Medicare reimbursement reference rate of $156.98, this hospital’s rate is 3.60x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$375

Average discount available for prompt cash payment at this facility.

Insurance Median

$565

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$156.98

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $156.98 (100%)

Cash / Self-Pay: $375 (239%)

Insurance Median: $565 (360%)

Cash: $375 (239% of Medicare)

Ins. Median: $565 (360% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $156.98 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 360% of the Medicare baseline (a markup of 260%). 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
Aetna	$180 - $610	115%
Blue Cross Blue Shield	$180 - $647	115%
Buckeye Community Health Plan	$180	115%
Humana	$180 - $712	115%
Medical Mutual Of Ohio	$180 - $476	115%
Medigold	$180	115%
Molina	$180	115%
Care Source	$184	117%
Gateway Health	$247	157%
Molina Marketplace	$295	188%
Care Source Just4Me	$324	206%
Sidecar Health	$495	315%
Ohio Ppo Connect	$525	334%
The Health Plan	$525	334%
Cigna	$543	346%
Medical Mutual Of Ohio Supermed	$565	360%
First Health	$588	375%
Ohio Health Choice	$597	380%
UnitedHealthcare	$645	411%
Integrated Health Plan	$705	449%
Healthsmart	$712	454%
Multiplan/Private Healthcare Systems	$712	454%
Three Rivers Network	$712	454%

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 $375.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 77066.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adena Pike Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 77066.
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.