CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Stoughton Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $285
Cash Discount Price: $265
vs. Medicare Baseline: 2.26x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Stoughton Hospital is $285. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $265. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 2.26x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$265

Average discount available for prompt cash payment at this facility.

Insurance Median

$285

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: $265 (210%)

Insurance Median: $285 (226%)

Cash: $265 (210% of Medicare)

Ins. Median: $285 (226% 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 226% of the Medicare baseline (a markup of 126%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Medicaid / KanCare	$56	44%
Tricare	$101 - $129	80%
Healthnet Mcr Adv - All Plans	$112 - $144	89%
Dean Health Insurance Med Adv	$118 - $151	93%
Humana	$118 - $486	93%
Quartz Mcr Adv	$118 - $151	93%
Security Health/First Health - All Plans	$118 - $151	93%
Aetna	$127 - $459	101%
UnitedHealthcare	$186 - $432	147%
Alliance - All Plans	$245 - $313	194%
Quartz Health Solutions - All Other Lans	$257	204%
Geha - All Plans	$317 - $405	251%
Cigna	$338 - $432	268%
Wisconsin Ppo Ppa Direct - All Plans	$338 - $432	268%
Blue Cross Blue Shield	$368 - $470	291%
Dean Health Insurance Comm - All Other Plans	$374	296%
Dean Health Insurance Epo	$374	296%
Wps - All Plans	$380 - $486	301%

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 $265.
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 Stoughton 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.