CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Sullivan County Community Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $170
Cash Discount Price: $420
vs. Medicare Baseline: 1.35x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Sullivan County Community Hospital is $170. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $420. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 1.35x the Medicare baseline. Located in 2200 N Section St, Sullivan, IN.

Cash / Self-Pay

$420

Average discount available for prompt cash payment at this facility.

Insurance Median

$170

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: $420 (333%)

Insurance Median: $170 (135%)

Cash: $420 (333% of Medicare)

Ins. Median: $170 (135% 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.

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
Humana	$69 - $476	55%
Mdwise Mcaid - All Other Plans	$69	55%
Mhs Mcaid - All Other Plans	$69	55%
Mhs Hlthy In Mcaid	$118	93%
Ambetter / Centene	$168	133%
Blue Cross Blue Shield	$168 - $296	133%
Mdwise Mcr Adv	$168	133%
Va Ccn - All Plans	$168	133%
Siho - All Plans	$420	333%
UnitedHealthcare	$476	377%

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 $420.
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 Sullivan County Community 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.