CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Good Samaritan Hospital of Suffern

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 77067
  • Insurance Median: $386
  • Cash Discount Price: $771
  • vs. Medicare Baseline: 3.06x Medicare
The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Good Samaritan Hospital of Suffern is $386. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $771. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 3.06x the Medicare baseline. Located in 255 Lafayette Avenue, Suffern, NY.
Cash / Self-Pay
$771

Average discount available for prompt cash payment at this facility.

Insurance Median
$386

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: $771 (611%)
Insurance Median: $386 (306%)
Cash: $771 (611% of Medicare)
Ins. Median: $386 (306% 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 306% of the Medicare baseline (a markup of 206%). 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 $77 - $308 61%
Self-Pay $84 67%
Hamaspik (McR) $109 86%
Medicare (plans) $109 - $116 86%
Mvp Gold (McR) $109 86%
Tricare $109 86%
Affinity By Molina McR $114 90%
Beacon Exchange $130 103%
Beacon Commercial $141 112%
Emblem $218 - $463 173%
Aetna $347 - $386 275%
Geisinger Health Commercial/Exchange $359 284%
Cigna $360 - $540 285%
Cdphp $386 306%
Self-Pay - Cc 50% $386 306%
Mvp Exchange $388 307%
Emblem Select Care (Exchange) $418 331%
Emblem Ghi/Hip PPO $492 390%
Magnacare Standard $540 428%
Multiplan $578 458%
PHCS $578 458%
Emblem Ghi/Hip Hmo/Epo/Pos $617 489%
Mvp $637 - $751 505%
First Health $655 519%
Magnacare Preferred $694 550%
Oxford Exchange $702 556%
Mvp Hmo/Ppo $754 597%
Oxford Commercial $755 598%
UnitedHealthcare $808 - $951 640%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 255 Lafayette Avenue, Suffern, NY 10901
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals