Screening mammogram (both breasts)
Facility: William Newton Hospital
Billing Code: 77067 (CPT)
- CPT Billing Code: 77067
- Insurance Median: $105
- Cash Discount Price: $216
- vs. Medicare Baseline: 0.83x 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 |
|---|---|---|
| Triwest- All Plans | $75 | 59% |
| UnitedHealthcare | $78 - $194 | 62% |
| Ambetter / Centene | $78 - $216 | 62% |
| Blue Cross Blue Shield | $78 - $153 | 62% |
| Providrs Care Nexus | $132 | 105% |
| Providrs Care - All Other Plans | $151 | 120% |
Consumer Guidance & Cost Commentary
For a screening mammogram at William Newton Hospital in Winfield, KS, the cash price is $216.00, which matches the facility's gross charge and the cash median. While the hospital is a Critical Access Hospital with a government-local ownership structure, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. For instance, UnitedHealthcare and Ambetter / Centene have negotiated ranges starting at $78 but extending up to $216, meaning patients with high-deductible plans might save money by paying the full cash price of $216.00 rather than relying on insurance, especially if their plan's allowed amount is high. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront payment incentives can bypass the standard insurance billing cycle and reduce the final cost.
The facility's pricing is benchmarked against Medicare, which sets a fixed rate of $126.25 for this procedure. The cash price of $216.00 represents a markup of approximately 70% over the Medicare amount, which falls within the range of fair pricing typically defined as 120% to 150% of Medicare, though commercial negotiated rates can sometimes reach 200% to 300% of this baseline. If a patient receives a bill from an out-of-network provider or encounters unexpected ancillary services, they may face balance billing for the difference between the provider's full charge and the insurance allowed amount; however, the No Surprises Act protects patients from such surprise bills for emergency care and non-emergency services at in-network