CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Methodist Southlake Medical Center

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 77067
  • Insurance Median: $207
  • Cash Discount Price: $358
  • vs. Medicare Baseline: 1.64x Medicare
The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Methodist Southlake Medical Center is $207. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $358. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 1.64x the Medicare baseline. Located in 421 E State Highway 114, Southlake, TX.
Cash / Self-Pay
$358

Average discount available for prompt cash payment at this facility.

Insurance Median
$207

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: $358 (284%)
Insurance Median: $207 (164%)
Cash: $358 (284% of Medicare)
Ins. Median: $207 (164% 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.

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 $126 - $525 100%
Blue Cross Blue Shield $126 - $319 100%
Medicare (plans) $126 - $135 100%
UnitedHealthcare $126 - $213 100%
Ust Health Proof [1005] $126 100%
Wellcare [7016] $126 100%
American Health Advantage Of Texas [7099] $132 105%
Cigna $132 - $233 105%
Globalhealth [1003] $132 105%
Procare Advantage [7018] $132 105%
Humana $133 105%
Southwestern Health Resources Swhr [7015] $133 105%
Provider Partners Health Plan [7025] $136 108%
Alternative Service Concepts [8005] $157 124%
Oscar Insurance Company [2057] $164 130%
Bright Healthcare [2222] $176 139%
Molina [3017] $182 144%
Wellpoint Marketplace Exchange [3071] $195 154%
Kempton Group Administrators, Tower Extrusions [3061] $201 159%
Bind Benefits Inc [1004] $206 163%
Definity Health [3006] $206 163%
Freedom Life Insurance Company [2029] $206 163%
Geha Federal [3066] $206 163%
Tml Intergovernmental Employee Benefits [3050] $206 163%
90 Degree Benefit [3057] $208 165%
Allied National [2031] $208 165%
Entrust/90 Degree [2058] $208 165%
Friday Health Plan [2061] $214 170%
Ambetter / Centene $215 170%
Imperial Insurance Companies [3073] $227 180%
Web Tpa [3049] $233 - $525 185%
Department Of Labor [8004] $252 200%
Evry Health [1013] $252 200%
Generic Workers Comp Tx Non Par [9010] $252 200%
Generic Workers Comp Tx Par [8002] $252 200%
Generic Workers Comp Tx Par [9011] $252 200%
Sana Benefits [3069] $252 200%
Tristar Risk Management [8006] $252 200%
Velocity [3070] $252 200%
Health Plans Inc [5017] $315 250%
Medical Cost Containment Professionals [3059] $315 250%
Dart Member Care [3039] $340 269%
Healthscope Benefits [2052] $340 269%
Healthscope Benefits [3063] $340 269%
Scott & White Health Plan Trs [3062] $376 - $427 298%
Medicaid / KanCare $695 - $958 550%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 421 E State Highway 114, Southlake, TX 76092
  • CMS Rating: No CMS Rating
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals