CMS Price Transparency Data

Diagnostic mammogram (both breasts)

Facility: Fort Memorial Hospital

Billing Code: 77066 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77066
Insurance Median: $109
Cash Discount Price: $108
vs. Medicare Baseline: 0.69x Medicare

The contracted insurance negotiated median rate for a Diagnostic mammogram (both breasts) at Fort Memorial Hospital is $109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $108. Compared to the federal Medicare reimbursement reference rate of $156.98, this hospital’s rate is 0.69x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$108

Average discount available for prompt cash payment at this facility.

Insurance Median

$109

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: $108 (69%)

Insurance Median: $109 (69%)

Cash: $108 (69% of Medicare)

Ins. Median: $109 (69% 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.

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
Blue Cross Blue Shield	$19 - $300	12%
Dean Health Plan	$19 - $356	12%
Medicaid / KanCare	$19	12%
Quartz	$19 - $1,101	12%
UnitedHealthcare	$20 - $211	13%
Managed Health Services	$21 - $41	13%
Molina	$40 - $158	25%
Mercycare	$43 - $404	27%
Humana	$44 - $156	28%
Centivo	$60 - $350	38%
Aetna	$71 - $407	45%
Group Health Cooperative	$75 - $351	48%
Trilogy	$109 - $478	69%
Cigna	$118 - $516	75%
Alliance	$122 - $390	78%
Fort Care	$149 - $500	95%
Veteran Evaluation Services	$263	168%

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 $108.
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 Fort Memorial Hospital 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.