CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: UPMC Chautauqua at Wca

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $222
Cash Discount Price: $205
vs. Medicare Baseline: 1.76x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at UPMC Chautauqua at Wca is $222. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $205. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 1.76x the Medicare baseline. Located in 207 Foote Avenue, Jamestown, NY.

Cash / Self-Pay

$205

Average discount available for prompt cash payment at this facility.

Insurance Median

$222

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: $205 (162%)

Insurance Median: $222 (176%)

Cash: $205 (162% of Medicare)

Ins. Median: $222 (176% 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	$117 - $222	93%
Upmc Health Plan	$131 - $205	104%
Univera	$134	106%
Geisinger	$146	116%
Health Partners Plans (Jefferson Health Plan)	$158	125%
Independent Health	$174 - $208	138%
Magnacare	$178 - $256	141%
UnitedHealthcare	$219 - $222	173%
Humana	$256 - $274	203%
Multiplan	$256	203%
Ghi/Emblem Health	$274	217%
Statewide Independent Ppo	$301	238%
Affordable First Health	$308	244%

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 $205.
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 UPMC Chautauqua at Wca 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.