Screening mammogram (both breasts)
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 77067 (CPT)
- CPT Billing Code: 77067
- Insurance Median: $138
- Cash Discount Price: $200
- vs. Medicare Baseline: 1.09x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $72 - $194 | 57% |
| Medicaid / KanCare | $72 - $138 | 57% |
| Medicare (plans) | $76 - $80 | 60% |
| Tricare | $76 | 60% |
| Aetna | $77 - $261 | 61% |
| Humana | $77 - $80 | 61% |
| Elara Caring Aspire Hospice [20433] | $80 | 63% |
| Halo Hcr Inc Hospice Contracted [320432] | $80 | 63% |
| Kindful Hospice [20434] | $80 | 63% |
| Mercy Hospice Okc [20252] | $80 | 63% |
| Dept Of Veteran Affairs Contracted [320106] | $80 | 63% |
| Cross Timbers Hospice [20098] | $80 | 63% |
| Halo Hcr Inc Hospice [20432] | $80 | 63% |
| Kindful Hospice Contracted [320434] | $80 | 63% |
| Pace Of The Ozarks Contracted [320518] | $80 | 63% |
| UnitedHealthcare | $83 - $207 | 66% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $84 | 67% |
| Medica Contracted [320239] | $112 | 89% |
| Ambetter / Centene | $138 | 109% |
| Home State Health Plan Contracted [320187] | $138 | 109% |
| Providrs Care Network Contracted [320484] | $154 | 122% |
| United Medical Resources Contracted [320454] | $207 | 164% |
| Health Choice Contracted [320166] | $225 | 178% |
| Yuzu Health Contracted [320521] | $246 | 195% |
| Mercy Benefit Admin Contracted [320251] | $246 | 195% |
| Aither Health Contracted [320449] | $246 | 195% |
| Auxiant Contracted [320462] | $246 | 195% |
| American Healthcare Alliance Contracted [320020] | $246 | 195% |
| Imagine 360 Contracted [320494] | $246 | 195% |
| Workers Comp [20426] | $246 | 195% |
| Healthlink Contracted [320179] | $246 | 195% |
| Edison Health Solutions Contracted [320502] | $246 | 195% |
| Ebms Contracted [320493] | $246 | 195% |
| Reflect Health Contracted [320492] | $246 | 195% |
| First Health Contracted [320128] | $261 | 207% |
| Cigna | $409 - $419 | 324% |
Consumer Guidance & Cost Commentary
For the screening mammogram (both breasts) at Mercy Hospital Pittsburg, Inc., the facility's cash price of $200.00 is notably higher than the state average of $184.00, though it remains below the gross charge of $307.00. While Medicare sets a benchmark of $126.25, commercial negotiated rates vary widely, ranging from $72 to $419 depending on the payer. For patients with high-deductible plans, paying the cash price of $200.00 upfront may be more cost-effective than relying on insurance, as many commercial payers negotiate rates that exceed the cash amount due to administrative overhead and contract structures. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront incentives can significantly reduce the final bill by bypassing the costly claims processing cycle.
The facility's negotiated rates reflect a complex landscape where in-network status does not guarantee the lowest possible price, as commercial contracts can range from 1.1 times the Medicare rate to over three times that amount. For instance, while Medicaid/KanCare and several hospice contracts pay $72 to $80, larger networks like UnitedHealthcare and Cigna negotiate rates as high as $207 and $419 respectively. To avoid unexpected costs, patients should verify their specific plan's allowed amount before scheduling, ensuring they understand whether their deductible has been met. Furthermore, if a patient receives care from an out-of-network provider, they may face balance billing for the difference between the provider's full charge and the insurance allowed amount; however, the No Surprises Act