CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Munson Healthcare Otsego Memorial Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $118
Cash Discount Price: $331
vs. Medicare Baseline: 0.93x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Munson Healthcare Otsego Memorial Hospital is $118. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $331. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 0.93x the Medicare baseline. Located in 825 N Center Ave, Gaylord, MI.

Cash / Self-Pay

$331

Average discount available for prompt cash payment at this facility.

Insurance Median

$118

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: $331 (262%)

Insurance Median: $118 (93%)

Cash: $331 (262% of Medicare)

Ins. Median: $118 (93% 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	$23 - $243	18%
Mclaren Health Plan	$23 - $326	18%
Meridian	$23 - $62	18%
Molina	$23 - $127	18%
Priority Health	$23 - $311	18%
UnitedHealthcare	$23 - $312	18%
Blue Care Network	$34 - $118	27%
Hap (Health Alliance Plan)	$34 - $311	27%
Humana	$34 - $118	27%
Medicare (plans)	$34 - $118	27%
Michigan Amish Medical Board	$34 - $118	27%
Northern Michigan Mennonite Group	$34 - $118	27%
Aetna	$35 - $315	28%
Asr Physicians Care Network	$52 - $311	41%
Cigna	$54 - $311	43%
Nomi Health	$55 - $311	44%
Employee Benefit Logistics	$59 - $200	47%
Hospice Of Michigan	$233	185%
Munson Hospice	$272 - $852	215%
Enterprise Group Planning/Employee Benefit Plan	$311	246%
Cofinity	$331	262%
Provider Network Of America/Hawaii Mainland Administrative Group Health	$331	262%
Three Rivers Provider Network	$331	262%

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 $331.
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 Munson Healthcare Otsego Memorial 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.