CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Kaleida Health

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $105
Cash Discount Price: $329
vs. Medicare Baseline: 0.83x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Kaleida Health is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $329. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 0.83x the Medicare baseline. Located in 100 High Street, Buffalo, NY.

Cash / Self-Pay

$329

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

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: $329 (261%)

Insurance Median: $105 (83%)

Cash: $329 (261% of Medicare)

Ins. Median: $105 (83% 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
Independent Health Association	$50 - $181	40%
Independent Health Association - Wchob	$52 - $181	41%
Blue Cross Blue Shield	$59 - $323	47%
Tricare	$82	65%
Univera	$85 - $135	67%
Wellcare	$90	71%
Aetna	$92 - $106	73%
Fidelis	$93	74%
UnitedHealthcare	$94	74%
Cigna	$101 - $123	80%
Ghi/Emblem Health	$102 - $127	81%
Ghi/Emblem Health - Wchob	$102 - $127	81%
Magnacare	$106 - $136	84%
Magnacare - Wchob	$106 - $136	84%
Univera - Wchob	$108 - $135	86%

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 $329.
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 Kaleida Health 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.