CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Wellspan Good Samaritan Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $152
Cash Discount Price: $225
vs. Medicare Baseline: 1.20x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Wellspan Good Samaritan Hospital is $152. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $225. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 1.20x the Medicare baseline. Located in 252 South 4Th Street, Lebanon, PA.

Cash / Self-Pay

$225

Average discount available for prompt cash payment at this facility.

Insurance Median

$152

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: $225 (178%)

Insurance Median: $152 (120%)

Cash: $225 (178% of Medicare)

Ins. Median: $152 (120% 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
Medicare (plans)	$83 - $90	66%
Aetna	$86 - $356	68%
Blue_Cross	$94 - $615	74%
Highmark	$129 - $303	102%
Medicaid / KanCare	$131 - $149	104%
Wellspan_Capital_Blue_Cross	$155	123%
Cigna	$222	176%
Geisinger	$256	203%
Upmc	$256	203%
Phc	$342	271%
First_Health_Network	$381	302%
United_Healthcare	$522	413%

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 $225.
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 Wellspan Good Samaritan 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.