Screening mammogram (both breasts)
Facility: Clara Barton Hospital
Billing Code: 77067 (CPT)
- CPT Billing Code: 77067
- Insurance Median: $282
- Cash Discount Price: $219
- vs. Medicare Baseline: 2.23x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 223% of the Medicare baseline (a markup of 123%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $122 | 97% |
| 6 Degrees Health - All Plans | $219 | 173% |
| Wppa-All Plans | $250 | 198% |
| UnitedHealthcare | $282 | 223% |
| Aetna | $282 | 223% |
| Phcs - All Plans | $282 | 223% |
| Hlth Partners Of Ks-All Plans | $288 | 228% |
Consumer Guidance & Cost Commentary
For the screening mammogram (both breasts) at Clara Barton Hospital in Hoisington, KS, the cash price of $219.00 is lower than the facility's negotiated rate of $282.00, which is the amount most insurance plans pay. While the facility's cash rate is significantly lower than the gross charge of $313.00, it is important to note that commercial negotiated rates often exceed cash prices due to administrative costs and contract structures. Patients with high-deductible plans may find paying the cash price of $219.00 more beneficial than using insurance, as the negotiated rate of $282.00 could result in higher out-of-pocket costs if the patient has not yet met their deductible. Additionally, patients should inquire about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill.
When evaluating the cost relative to Medicare, the facility's cash rate of $219.00 is 2.2 times the Medicare benchmark of $126.25. This markup is consistent with commercial pricing dynamics where negotiated rates typically range from 200% to 300% of Medicare amounts, whereas fair pricing is often defined as 120% to 150% of the Medicare rate. Although specific county or state average comparisons are not provided in this data, the facility operates as a Critical Access Hospital with a voluntary non-profit ownership structure, which may influence its pricing strategy. To ensure accuracy, patients should request a full itemized bill to verify that no unbundled codes or services not rendered are included, as over 80%