CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Good Samaritan Medical Center

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $141
Cash Discount Price: $93
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Good Samaritan Medical Center is $141. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $93. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 1.12x the Medicare baseline. Located in 235 North Pearl Street, Brockton, MA.

Cash / Self-Pay

$93

Average discount available for prompt cash payment at this facility.

Insurance Median

$141

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: $93 (74%)

Insurance Median: $141 (112%)

Cash: $93 (74% of Medicare)

Ins. Median: $141 (112% 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
Aetna	$109 - $319	86%
Blue Cross Blue Shield	$109 - $221	86%
Humana	$109	86%
Medicare (plans)	$109 - $141	86%
Neighborhood Pace [1206]	$109	86%
Ubh Hphc [8016]	$109	86%
United Community Plan [1202]	$109	86%
UnitedHealthcare	$109	86%
Veterans Admin [9003]	$109	86%
Zzzcovid19 Hrsa Uninsured Testing And Treatment Fund [500010]	$109	86%
Eternalhealth [1227]	$115	91%
Mass General Brigham Health Plan Commercial [8009]	$120	95%
Mass General Brigham Health Plan Prime [7003]	$120	95%
Cigna	$124 - $378	98%
Cca [1215]	$141	112%
Fallon [8008]	$141	112%
Zzzcca Onecare [1216]	$141	112%
Unicare [8004]	$155	123%
Wellpoint [2034]	$155	123%
Senior Whole Health [1210]	$163	129%
Harvard Pilgrim Health Care [8001]	$194	154%
Meritain Health [1023]	$319	253%
Tufts [8002]	$322 - $378	255%
Hsn Bad Debt [4003]	$395	313%
Hsn Confidential [4007]	$395	313%
Hsn Dental [4006]	$395	313%
Hsn Partial [4002]	$395	313%
Hsn [4001]	$395	313%

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 $93.
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 Good Samaritan Medical Center 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.