Screening mammogram (both breasts)
Facility: Hiawatha Community Hospital
Billing Code: 77067 (CPT)
- CPT Billing Code: 77067
- Insurance Median: $280
- Cash Discount Price: $345
- vs. Medicare Baseline: 2.22x 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 222% of the Medicare baseline (a markup of 122%). 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 |
|---|---|---|
| Aetna | $112 - $312 | 89% |
| UnitedHealthcare | $112 - $332 | 89% |
| Humana | $113 - $144 | 90% |
| Ambetter / Centene | $135 - $171 | 107% |
| Blue Cross Blue Shield | $153 - $161 | 121% |
| Centrus Health Direct - All Plans | $227 - $290 | 180% |
| Oscar - All Plans | $227 - $290 | 180% |
| Preferred Hlth - All Plans | $273 - $347 | 216% |
| Wppa Providrs Care - All Plans | $288 - $367 | 228% |
| Cigna | $288 - $367 | 228% |
| Midlands Choice - All Plans | $294 - $374 | 233% |
| Multiplan - All Plans | $294 - $374 | 233% |
| Healthy Blue Mcaid - All Plans | $303 - $386 | 240% |
Consumer Guidance & Cost Commentary
For a screening mammogram at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $345.00, which matches the facility's median paid amount. While the hospital is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. In this case, the median negotiated rate across payers is $280.00, which is lower than the cash price, meaning insurance coverage would likely result in a lower out-of-pocket cost for most members. However, if a patient has a high-deductible plan that has not yet met their deductible, paying the cash price of $345.00 upfront could be more cost-effective than facing a negotiated rate that exceeds their personal financial threshold.
The facility's pricing is benchmarked against Medicare, which sets the baseline reimbursement at $126.25 for this procedure. The cash price represents a 2.2x markup relative to the Medicare amount, a figure that reflects the facility's specific cost structure and local wage index. While the data provided does not include explicit state or county average comparisons for this specific code, the facility's status as a Critical Access Hospital often influences its pricing strategy to remain competitive within the region. Patients are encouraged to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can further reduce the final bill if payment is made in full prior to service. Additionally, if a patient receives care from an out-of-network provider at this facility, the No Surprises Act protects them from balance billing for emergency services and non-emergency services provided at in-network facilities.