Screening mammogram (both breasts)
Facility: Decatur Health
Billing Code: 77067 (CPT)
- CPT Billing Code: 77067
- Insurance Median: $434
- Cash Discount Price: $511
- vs. Medicare Baseline: 3.44x 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 344% of the Medicare baseline (a markup of 244%). 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 | $159 | 126% |
| Wppa/Providrs Care- All Plans | $341 | 270% |
| UnitedHealthcare | $347 - $434 | 275% |
| Humana | $350 | 277% |
| Aetna | $511 - $568 | 405% |
| Midlands Choice- All Plans | $511 | 405% |
| Medicaid / KanCare | $574 | 455% |
Consumer Guidance & Cost Commentary
For the screening mammogram (both breasts) at Decatur Health in Oberlin, KS, the facility's cash price of $511.00 is notably lower than the median negotiated rate of $392.00 paid by commercial insurers, which averages $392.00 across payers. This cash price aligns closely with the cash median of $511.00, making it a potentially more affordable option for patients with high-deductible plans who may not yet have met their out-of-pocket limits. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the negotiated rates range from $159 for Blue Cross Blue Shield to $574 for Medicaid/KanCare, reflecting significant variation based on payer contracts. Patients should verify their specific plan's allowed amount before scheduling, as in-network status does not guarantee the lowest possible price, and some commercial rates can exceed the cash-pay option.
To maximize savings, patients should proactively request "self-pay" or "prompt-pay" discounts from the billing department before check-in, as these upfront payment incentives can reduce the final balance by 20% to 50% by bypassing administrative claim processing costs. It is also important to review the itemized bill carefully, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that should be corrected before payment. When evaluating the facility's pricing against the broader market, the gross charge of $568.00 represents a significant markup over the Medicare benchmark of $126.25, which serves as the objective baseline for fair pricing. By comparing the facility's rates directly to the