CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Virginia Gay Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $281
Cash Discount Price: $289
vs. Medicare Baseline: 2.23x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Virginia Gay Hospital is $281. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $289. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 2.23x the Medicare baseline. Located in 502 North 9Th Avenue, Vinton, IA.

Cash / Self-Pay

$289

Average discount available for prompt cash payment at this facility.

Insurance Median

$281

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: $289 (229%)

Insurance Median: $281 (223%)

Cash: $289 (229% of Medicare)

Ins. Median: $281 (223% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 223% of the Medicare baseline (a markup of 123%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$108	86%
Medicaid / KanCare	$117 - $161	93%
Health Alliance Mcr Adv	$133 - $146	105%
UnitedHealthcare	$162 - $178	128%
Wellmark Hmo	$221	175%
Wellmark Ppo-All Other Plans	$243	192%
Medical Associates-All Plans	$255 - $281	202%
Cedar Valley Community Healthcare-All Plans	$268 - $295	212%
Humana	$272 - $300	215%
Health Partners-All Plans	$289 - $319	229%
Healthsmart-All Plans	$295 - $319	234%
Corvel-All Plans	$316 - $349	250%
Health Alliance-All Other Plans	$323 - $356	256%

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 $289.
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 Virginia Gay 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.