CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Dundy County Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $228
Cash Discount Price: $306
vs. Medicare Baseline: 1.81x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Dundy County Hospital is $228. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $306. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 1.81x the Medicare baseline. Located in P O Box 626, 1313 North Cheyenne St, Benkelman, NE.

Cash / Self-Pay

$306

Average discount available for prompt cash payment at this facility.

Insurance Median

$228

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: $306 (242%)

Insurance Median: $228 (181%)

Cash: $306 (242% of Medicare)

Ins. Median: $228 (181% 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
Molina	$166 - $175	131%
UnitedHealthcare	$166 - $227	131%
Medica	$183 - $193	145%
Blue Cross Blue Shield	$215 - $349	170%
Total Care	$217 - $229	172%
Wellcare	$219 - $231	173%
Midlands Choice	$248 - $262	196%
Multiplan	$324 - $342	257%
Aetna	$469 - $495	371%

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 $306.
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 Dundy County 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.