Screening mammogram (both breasts)
Facility: Stormont Vail Hospital
Billing Code: 77067 (CPT)
- CPT Billing Code: 77067
- Insurance Median: $104
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.82x 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 |
|---|---|---|
| UnitedHealthcare | $74 - $104 | 59% |
| Ambetter / Centene | $74 - $104 | 59% |
| Blue Cross Blue Shield | $74 - $161 | 59% |
Consumer Guidance & Cost Commentary
For this screening mammogram service at Stormont Vail Hospital in Topeka, Kansas, the facility's negotiated payment rates range from $74 to $161 depending on your specific insurance plan, with a median negotiated amount of $104. This rate is significantly lower than the facility's gross charge of $340, reflecting standard insurance contract caps. While the facility's negotiated rate of $104 is slightly higher than the state average of $105, it remains well below the Medicare benchmark of $126.25. For patients with high-deductible plans or those without insurance, paying cash directly may be more cost-effective, as the cash median is not listed but could potentially be lower than the $104 insurance allowed amount. It is important to note that commercial negotiated rates often include administrative overhead for claims processing, which can inflate the baseline price compared to the true cost of care represented by Medicare benchmarks.
Patients should be aware that hospitals frequently offer prompt-pay discounts, typically ranging from 20% to 50% off the billed amount, for those who pay in full upfront within a short window, such as 30 days. These discounts bypass the costly insurance billing cycle and administrative fees, potentially reducing the total cost significantly below the $104 negotiated rate. To secure this discount, patients must request self-pay classification and prompt-pay rates before check-in and may need to sign a waiver to prevent the hospital from automatically submitting a claim to their insurance. Additionally, under the No Surprises Act, patients are protected from balance billing for out-of-network services at in-network facilities, though they should still review their itemized bill to ensure no unbundled codes