CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Adena Pike Medical Center

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 77067
  • Insurance Median: $217
  • Cash Discount Price: $144
  • vs. Medicare Baseline: 1.72x Medicare
The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Adena Pike Medical Center is $217. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $144. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 1.72x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.
Cash / Self-Pay
$144

Average discount available for prompt cash payment at this facility.

Insurance Median
$217

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: $144 (114%)
Insurance Median: $217 (172%)
Cash: $144 (114% of Medicare)
Ins. Median: $217 (172% 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.

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 $69 - $234 55%
Blue Cross Blue Shield $69 - $248 55%
Buckeye Community Health Plan $69 55%
Humana $69 - $273 55%
Medical Mutual Of Ohio $69 - $183 55%
Medigold $69 55%
Molina $69 55%
Care Source $70 55%
Gateway Health $95 75%
Molina Marketplace $113 90%
Care Source Just4Me $124 98%
Sidecar Health $190 150%
Ohio Ppo Connect $201 159%
The Health Plan $201 159%
Cigna $208 165%
Medical Mutual Of Ohio Supermed $217 172%
First Health $225 178%
Ohio Health Choice $229 181%
UnitedHealthcare $247 196%
Integrated Health Plan $270 214%
Healthsmart $273 216%
Multiplan/Private Healthcare Systems $273 216%
Three Rivers Network $273 216%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 100 Dawn Lane, Waverly, OH 45690
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals