Screening mammogram (both breasts)
Facility: Holton Community Hospital
Billing Code: 77067 (CPT)
- CPT Billing Code: 77067
- Insurance Median: $185
- Cash Discount Price: $167
- vs. Medicare Baseline: 1.47x 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 |
|---|---|---|
| Aetna | $118 - $223 | 93% |
| UnitedHealthcare | $118 - $223 | 93% |
| Humana | $119 | 94% |
| Kansas Superior Select - All Plans | $121 | 96% |
| Blue Cross Blue Shield | $122 | 97% |
| Preferred Health Fn Select - All Other Plans | $185 | 147% |
| Preferred Health Freedom | $185 | 147% |
| Preferred Health Professionals | $185 | 147% |
| Wppa Providers - All Plans | $212 | 168% |
| Medicaid / KanCare | $223 | 177% |
Consumer Guidance & Cost Commentary
For this screening mammogram at Holton Community Hospital in Holton, Kansas, the negotiated rates range from $118 to $223 depending on your specific insurance plan, with the highest negotiated amount being $223. This facility is a Critical Access Hospital with a voluntary non-profit ownership structure. While the cash price is $167 and the median amount paid by insurance is $137, patients should be aware that commercial negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. If you have a high-deductible plan, paying the cash price of $167 upfront might be more cost-effective than relying on insurance, which could result in a higher allowed amount that you must cover out-of-pocket before your deductible is met.
To ensure you are getting the best possible rate, it is crucial to verify your specific plan's negotiated amount before scheduling, as in-network rates can vary significantly between carriers. The Medicare benchmark for this service is $126.25, which serves as an objective baseline for fair pricing; commercial negotiated rates are often higher than this federal standard due to the inclusion of administrative costs and risk adjustments. Additionally, you should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if you pay in full upfront, bypassing the costly claims processing cycle. Always request an itemized bill before paying to ensure accuracy and avoid unexpected charges.