Navigating the Maze of Mammogram Payment: A Peek at Surprising Disparities

October is National Breast Cancer Awareness Month, a time when pink ribbons adorn everything from NFL helmets to yogurt cups. Amidst this sea of pink, Hospital Pricing Specialists decided to tackle a less colorful, though equally important topic: the puzzling world of mammogram pricing. You'd think that the cost for a screening mammogram (CPT 77067) would be as consistent as your grandma's meatloaf recipe, but think again!

According to a revealing analysis done in collaboration with DeductibleData, examining Anthem's payment rates to hospitals, it turns out that not all mammograms are priced equally. The disparities are so wide that one might suspect some hospitals of using gold-plated mammography machines.

Here's the lowdown:

*** Critical Access Hospitals (CAHs) are paid a humble $235.28, about 48% lower than the national average of $451.11. It seems even the imaging technology is taking a critical hit here.

*** Teaching Hospitals roll at the higher end with $539.22, roughly 20% above the national average. Maybe those extra dollars help mold the bright minds of tomorrow-or maybe they're just lost in the academic labyrinth.

*** Non-Teaching Hospitals receive $352.62, which is 22% below average. It's the academic version of 'middle child syndrome' in pricing.

For Bed Capacity:

*** Small hospitals (under 100 beds) get 21% less than the average; maybe it's a size thing?

*** Medium hospitals (100-300 beds) find themselves 34% below; not big enough to be large, not small enough to be quaint.

*** Large hospitals (over 300 beds), meanwhile, enjoy a plush 31% above average. Size does matter, at least when it comes to getting paid.

Why the vast differences? It's not like larger hospitals use a magical mammogram machine. One possible explanation could be related to bargaining power, administrative overhead, or simply because everything is bigger in the large hospitals-including the bills.

The quirks in this pricing maze are more bewildering than trying to understand why we say "pair of pants" when it's just one item. If you're baffled by these numbers or just yearn for more enlightenment on this or any other payer's pricing habits, Hospital Pricing Specialists are your go-to. We guarantee to clarify hospital payment rates by analyzing the amounts payers claim to pay in their machine-readable files.

Rick Louie
Managing Director
1484 Pollard Road, #536
Los Gatos, CA 95032

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Hospital Pricing Specialists has been actively engaged in over 1,200 successful pricing projects, encompassing critical access hospitals and healthcare systems with over 3,500 beds. We provide state-of-the-art, fully managed, and hosted cloud solutions specifically designed to meet the needs of hospitals in today's challenging reimbursement environment and the intricate demands of CMS price transparency requirements.

This release was published on openPR.