CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Lonesome Pine Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $94
Cash Discount Price: $72
vs. Medicare Baseline: 0.74x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Lonesome Pine Hospital is $94. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 0.74x the Medicare baseline. Located in 1990 Holton Avenue East, Big Stone Gap, VA.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$94

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: $72 (57%)

Insurance Median: $94 (74%)

Cash: $72 (57% of Medicare)

Ins. Median: $94 (74% 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.

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	$31 - $211	25%
Blue Cross Blue Shield	$31 - $494	25%
Molina Healthcare	$31 - $94	25%
Optima Health	$31 - $61	25%
UnitedHealthcare	$31 - $494	25%
Amerigroup	$83 - $90	66%
Humana	$90	71%
Managed Medicaire	$90	71%
Medicare (plans)	$90	71%
Sentara Health	$90 - $125	71%
United Mine Workers Of America	$90	71%
Cigna	$94 - $206	74%
Devoted Health Plan	$94	74%
Mountain Empire Pace	$94	74%
Nhc Advantage	$94	74%
Wellcare	$95	75%
Ambetter / Centene	$195	154%
Seven Corners, Inc.	$215	170%
Medcost	$223 - $235	177%
First Health Coventry	$422 - $445	334%

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 $72.
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 Lonesome Pine 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.