Screening mammogram (both breasts)
Facility: Memorial Hospital
Billing Code: 77067 (CPT)
- CPT Billing Code: 77067
- Insurance Median: $323
- Cash Discount Price: $359
- vs. Medicare Baseline: 2.56x 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 256% of the Medicare baseline (a markup of 156%). 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 | $130 | 103% |
| Tricare | $167 - $334 | 132% |
| Humana | $167 - $334 | 132% |
| Medicare (plans) | $169 - $337 | 134% |
| Ambetter / Centene | $184 - $368 | 146% |
| Coventry - All Other Plans | $301 - $601 | 238% |
| Health Partners Of Kansas - All Plans | $317 - $635 | 251% |
| Preferred Healthcare-All Plans | $317 - $635 | 251% |
| Wppa/Providers Care-All Plans | $467 - $935 | 370% |
Consumer Guidance & Cost Commentary
For this screening mammogram procedure, the cash price at Memorial Hospital in Abilene is $359.00, which matches the facility's median cash rate. While commercial insurance plans like Blue Cross Blue Shield and Tricare negotiate rates ranging from $130 to $635 depending on the specific plan, patients with high-deductible or self-pay plans might find the cash price more affordable than their insurance allowed amount. It is important to note that commercial negotiated rates often include administrative overhead and can exceed the cash price; therefore, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can significantly lower the final cost.
The facility's pricing is benchmarked against the Medicare rate of $126.25, which serves as the objective baseline for evaluating hospital markups. Commercial negotiated rates for this service average between 200% and 300% of the Medicare amount, whereas fair pricing is typically defined as 120% to 150% of the Medicare rate. Since this facility is a Critical Access Hospital in Kansas, its billing practices are subject to specific federal protections, including the No Surprises Act, which bans balance billing for out-of-network providers at in-network facilities. Patients should review their itemized bill carefully to ensure no unbundled codes or services not rendered are included, and if they receive a surprise balance bill, they should dispute it in writing rather than paying immediately to protect their financial rights.