Screening mammogram (both breasts)
Facility: Nmc Health
Billing Code: 77067 (CPT)
- CPT Billing Code: 77067
- Insurance Median: $207
- Cash Discount Price: $205
- vs. Medicare Baseline: 1.64x 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 |
|---|---|---|
| Wppa | $146 - $175 | 116% |
| Occunet | $160 - $191 | 127% |
| Blue Cross Blue Shield | $161 | 128% |
| Medincrease Health Plan | $173 - $207 | 137% |
| Samaritan Ministries International | $173 - $207 | 137% |
| Prime Health Services | $200 - $239 | 158% |
| Aetna | $219 - $262 | 173% |
| UnitedHealthcare | $239 - $286 | 189% |
| Cigna | $253 - $302 | 200% |
Consumer Guidance & Cost Commentary
For this screening mammogram at Nmc Health in Newton, KS, the facility's cash price of $205 is lower than the state average of $292, making it a potentially cost-effective option for patients with high-deductible plans or those paying out-of-pocket. While the facility's negotiated rates with major payers like UnitedHealthcare and Cigna range from $239 to $302, these amounts are significantly higher than the cash price. Because commercial insurance rates often include administrative overhead and contract markups, paying cash directly can sometimes result in lower out-of-pocket costs compared to insurance reimbursement, provided the patient's plan has a high deductible or no coverage for this service.
To ensure you receive the best possible rate, it is important to verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these can further reduce the final bill. Additionally, while the facility's gross charge is $292, the Medicare benchmark of $126.25 serves as a reliable baseline for evaluating pricing fairness, showing that the commercial rates reflect standard market dynamics rather than arbitrary list prices. If you receive a bill from an out-of-network provider at this in-network facility, remember that the No Surprises Act protects you from balance billing for emergency and non-emergency services, so do not feel pressured to pay unexpected differences immediately; instead, request an itemized audit to identify any unbundled codes or services not rendered.