CMS Price Transparency Data

Diagnostic mammogram (both breasts)

Facility: Good Samaritan Medical Center LLC

Billing Code: 77066 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 77066
  • Insurance Median: $353
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 2.25x Medicare
The contracted insurance negotiated median rate for a Diagnostic mammogram (both breasts) at Good Samaritan Medical Center LLC is $353. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $156.98, this hospital’s rate is 2.25x the Medicare baseline. Located in 200 Exempla Cir, Lafayette, CO.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$353

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%)
Insurance Median: $353 (225%)
Ins. Median: $353 (225% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 225% of the Medicare baseline (a markup of 125%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

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
Kaiser Perm Hmo $114 - $260 73%
Kaiser Self Funded $142 - $260 90%
Kaiser Perm Ppo/Pos $144 - $268 92%
Allegiance $154 98%
Cigna $154 - $616 98%
Aarp $158 101%
UnitedHealthcare $158 - $357 101%
Kaiser Snp $160 102%
Select Health $160 102%
Aetna $229 - $553 146%
Blue Cross Blue Shield $245 - $519 156%
Geha $246 - $419 157%
Preferred One $246 - $419 157%
Humana $259 165%
Denv Hlth Med Plan $416 265%
Cofinity $444 283%
First Health Network $444 283%
Private Hlthcare Sys $462 294%
Multiplan Inc $524 334%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 200 Exempla Cir, Lafayette, CO 80026
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals