CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Ascension Providence Hospital, Southfield and Novi

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $85
Cash Discount Price: $166
vs. Medicare Baseline: 0.67x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Ascension Providence Hospital, Southfield and Novi is $85. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $166. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 0.67x the Medicare baseline. Located in 16001 W Nine Mile Rd, Southfield, MI.

Cash / Self-Pay

$166

Average discount available for prompt cash payment at this facility.

Insurance Median

$85

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: $166 (131%)

Insurance Median: $85 (67%)

Cash: $166 (131% of Medicare)

Ins. Median: $85 (67% 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 Caid Michigan	$47	37%
Harbor Health Mcd	$47	37%
Medicaid / KanCare	$47 - $82	37%
Molina Health	$47	37%
Total Health Care	$47	37%
UnitedHealthcare	$47	37%
Amerihealth Vip Care Mcr	$70 - $81	55%
Aetna	$82 - $264	65%
Auto Insurance	$82	65%
Jvhl - Mcr Replacement	$82	65%
Mcr Replacement	$82	65%
Veterans Choice	$82	65%
Humana	$83	66%
Hap Alliance Health	$85	67%
Hap Hmo Pos	$85	67%
Meridian Wellcare	$86	68%
Molina Advantage	$86	68%
Bcccp	$97	77%
Hap Preferred	$100	79%
Priority Ppo	$100	79%
Ambetter / Centene	$102	81%
Molina Marketplace	$102	81%
Smart Health	$113	90%
Priority Health Hmo	$117	93%
Bc Metro Detroit Hmo	$167 - $187	132%
Bcn Local Network Southeast	$167 - $187	132%
Bc Metro Detroit Epo	$185 - $187	147%
Blue Care Network	$185 - $187	147%
Blue Cross Blue Shield	$185 - $187	147%

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 $166.
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 Ascension Providence Hospital, Southfield and Novi 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.