Bilateral breast tomosynthesis imaging at Forsyth Memorial Hospital, Inc.

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

SCRN BREAST TOMOSYNTHESIS

Winston-Salem, NC

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Pricing by billing methodology

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How this price compares nationally

Forsyth Memorial Hospital, Inc.’s median price of $97 is 94% above the median hospital's median price ($50), higher than 84% of the 2,403 hospitals reporting CPT 77063. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting CPT 77063 at Forsyth Memorial Hospital, Inc.

Negotiated rates from the hospital’s own file: 11 payers, 25 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	Blue Cross Blue Shield healthy blue medicaid fee schedule · outpatient	$26.70	$26.70	$26.70 – $26.70
2	UnitedHealthcare medicaid fee schedule · outpatient	$26.70	$26.70	$26.70 – $26.70
3	WellCare medicaid fee schedule · outpatient	$26.70	$26.70	$26.70 – $26.70
4	Cigna aca fee schedule · outpatient	$54.56	$54.56	$54.56 – $54.56
5	Caresource qualified health plan fee schedule · outpatient	$56.40	$56.40	$56.40 – $56.40
6	Aetna medicare fee schedule · outpatient	$70.50	$70.50	$70.50 – $70.50
7	Blue Cross Blue Shield blue home fee schedule · outpatient	$73.60	$73.60	$73.60 – $73.60
8	Cigna commercial percent of total billed charges · outpatientfrom % of charges	$74.54	$74.54	$74.54 – $74.54
9	Blue Cross Blue Shield blue value fee schedule · outpatient	$76.14	$76.14	$76.14 – $76.14
10	Cigna commercial fee schedule · outpatient	$83.75	$83.75	$83.75 – $83.75
11	Aetna commercial fee schedule · outpatient	$86.85	$86.85	$86.85 – $86.85
12	UnitedHealthcare all payer fee schedule · outpatient	$94.89	$94.89	$94.89 – $94.89
13	Blue Cross Blue Shield hmo fee schedule · outpatient	$96.86	$96.86	$96.86 – $96.86
14	Blue Cross Blue Shield ppo fee schedule · outpatient	$96.86	$96.86	$96.86 – $96.86
15	Humana commercial fee schedule · outpatient	$109.83	$109.83	$109.83 – $109.83
16	Aetna aca fee schedule · outpatient	$112.80	$112.80	$112.80 – $112.80
17	Aetna first health fee schedule · outpatient	$112.80	$112.80	$112.80 – $112.80
18	Aetna non-par products of apcn fee schedule · outpatient	$112.80	$112.80	$112.80 – $112.80
19	Aetna rental network products fee schedule · outpatient	$112.80	$112.80	$112.80 – $112.80
20	Aetna whole health non-multitier fee schedule · outpatient	$112.80	$112.80	$112.80 – $112.80
21	Medcost mbs fee schedule · outpatient	$119.85	$119.85	$119.85 – $119.85
22	Beechstreet commercial fee schedule · outpatient	$126.90	$126.90	$126.90 – $126.90
23	MultiPlan all plans fee schedule · outpatient	$126.90	$126.90	$126.90 – $126.90
24	Phcs all plans fee schedule · outpatient	$126.90	$126.90	$126.90 – $126.90
25	Medcost non-mbs fee schedule · outpatient	$132.54	$132.54	$132.54 – $132.54

Last updated: Mar 30, 2026

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