CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 77067
  • Insurance Median: $407
  • Cash Discount Price: $222
  • vs. Medicare Baseline: 3.22x Medicare
The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Carilion Stonewall Jackson Hospital is $407. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $222. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 3.22x the Medicare baseline. Located in 1 Health Circle, Lexington, VA.
Cash / Self-Pay
$222

Average discount available for prompt cash payment at this facility.

Insurance Median
$407

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: $222 (176%)
Insurance Median: $407 (322%)
Cash: $222 (176% of Medicare)
Ins. Median: $407 (322% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 322% of the Medicare baseline (a markup of 222%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

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
Blue Cross Blue Shield $129 102%
Sentara Health Plan $131 - $393 104%
Abh of VA (Formerly Coventry) $135 107%
Abh of Wva (Formerly Coventry) $135 107%
Humana $135 107%
UnitedHealthcare $135 - $518 107%
Aetna $323 - $421 256%
Gateway - Tier 3 $349 276%
Vhn - Ultra $393 311%
Connecticare $444 352%
Gateway - Tier 2 $507 402%
Vhn - Plus $507 402%
Cigna $508 402%
Integrated Health Plan $539 427%
Vhn $539 427%
Vhn - Link $571 452%
Beech Street $583 462%
Gateway - Tier 1 $602 477%
Vhn - Secondary Payors $602 477%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1 Health Circle, Lexington, VA 24450
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals