CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: T J Samson Community Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $115
Cash Discount Price: $140
vs. Medicare Baseline: 0.91x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at T J Samson Community Hospital is $115. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $140. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 0.91x the Medicare baseline. Located in 1301 North Race Street, Glasgow, KY.

Cash / Self-Pay

$140

Average discount available for prompt cash payment at this facility.

Insurance Median

$115

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$126.25

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $126.25 (100%)

Cash / Self-Pay: $140 (111%)

Insurance Median: $115 (91%)

Cash: $140 (111% of Medicare)

Ins. Median: $115 (91% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$34 - $237	27%
Center Care Select - All Plans	$34 - $237	27%
Signature Health - All Plans	$34 - $116	27%
Wellcare Mcr Adv - All Other Plans	$34 - $115	27%
Molina Mcr Adv	$35 - $117	28%
Devoted Mcr Adv - All Plans	$36 - $121	29%
Humana	$36 - $115	29%
Caresource - All Plans	$44 - $173	35%
Molina Marketplace - All Other Plans	$44 - $173	35%
Aetna	$91 - $103	72%
Wellcare Mcaid	$91 - $113	72%
Molina Mcaid	$94 - $106	74%
UnitedHealthcare	$168 - $217	133%
Phcs/Multiplan - All Plans	$203 - $262	161%
First Health - All Plans	$205 - $265	162%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $140.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 77067.

Insurance In-Network Protection Plan

Contact your insurance company to confirm T J Samson Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 77067.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.