CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Medical City Alliance

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $98
Cash Discount Price: $789
vs. Medicare Baseline: 0.78x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Medical City Alliance is $98. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $789. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 0.78x the Medicare baseline. Located in 3101 North Tarrant Parkway, Fort Worth, TX.

Cash / Self-Pay

$789

Average discount available for prompt cash payment at this facility.

Insurance Median

$98

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: $789 (625%)

Insurance Median: $98 (78%)

Cash: $789 (625% of Medicare)

Ins. Median: $98 (78% 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
Superior Health Plan	$55 - $94	44%
Humana	$87 - $401	69%
Blue Cross Blue Shield	$89 - $425	70%
Triwest Health Alliance	$89	70%
Wellmed	$89	70%
Amerigroup	$90	71%
Devoted Health	$90	71%
Mutual Of Omaha	$90	71%
Triwest Veterans	$90	71%
United	$90 - $217	71%
Aetna	$91 - $574	72%
Care N Care	$91	72%
Cigna	$92 - $110	73%
Integranet	$93	74%
Wellcare	$93	74%
American Health Plan Of Texas, Inc.	$94	74%
Procare Advantge	$94	74%
Provider Partners Health Plan	$95	75%
Texas Independent Health Plan	$95	75%
Molina	$98	78%
Imperial Insurance Company	$99	78%
Verda Health Plan	$117	93%
Superior	$161 - $201	128%
Healthcare Highways	$193 - $267	153%
Evry Health	$204	162%
Molina Healthcare	$235	186%
Curative Administrators	$316	250%
Multiplan Phcs	$552	437%
Healthsmart Preferred Care	$592	469%
Independent Medical Systems	$789	625%
National Healthcare Solutions	$789	625%

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 $789.
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 Medical City Alliance 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.