Summit Pacific Medical Center

ElmaGrays Harbor CountyCritical Access Hospitals

Mammogram (both breasts)

Quality: 2 of 5 (CMS overall rating)Earliest available date: call (360) 346-2222

What you may pay

With insurance from an employer or private plan: $396 to $509Depends on your plan. Each plan’s price at this hospital:
CHPW PEBB - ALL OTHER PLANS $396 Higher than typical
FIRST CHOICE - ALL PLANS $452 Higher than typical
AETNA COMM - ALL PLANS $509 Higher than typical
Typical at 36 hospitals we cover: $195 to $342 (each hospital’s middle plan price, hospital’s fee). Don’t see your plan? Ask your insurer for its rate here.
Paying yourself (cash price): $305 Lower than typicalTypical hospital’s fee at 41 hospitals we cover: $308 to $509.

These are prices the hospital published, not a quote. With insurance you usually pay part of the rate (your deductible and coinsurance); the estimator on the procedure page works it out. A higher price does not mean better care.

Doctors usually bill separately. At most hospitals these are the hospital’s own charges. The surgeon, radiologist, anesthesiologist or pathologist usually sends a separate bill: ask each of them for an estimate too.

Source: Summit Pacific Medical Center’s own price file, dated 2026-08-31. CareNavIQ last refreshed prices on 2026-11-09.

Next step: ask the hospital for a Good Faith Estimate for this procedure (phone number above).

15 published prices, grouped by who each price applies to.

Cash price 1 price

The hospital's discounted price for patients paying without insurance.

Cash price prices for Mammogram (both breasts) at Summit Pacific Medical Center
Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
$305	Hospital’s fee	Diagnostic mammography of both breasts	—	Outpatient	2026-08-31

List price (before discounts) 1 price

The hospital's full chargemaster price. Few patients pay this amount.

List price (before discounts) prices for Mammogram (both breasts) at Summit Pacific Medical Center
Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
$565	Hospital’s fee	Diagnostic mammography of both breasts	—	Outpatient	2026-08-31

Commercial insurance 3 prices

Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.

Commercial insurance prices for Mammogram (both breasts) at Summit Pacific Medical Center
Payer	Plan	Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
AETNA COMM - ALL PLANS	AETNA COMM - ALL PLANS	$509	Hospital’s fee	Diagnostic mammography of both breasts	percent of total billed charges	Outpatient	2026-08-31
CHPW PEBB - ALL OTHER PLANS	CHPW PEBB - ALL OTHER PLANS	$396	Hospital’s fee	Diagnostic mammography of both breasts	percent of total billed charges	Outpatient	2026-08-31
FIRST CHOICE - ALL PLANS	FIRST CHOICE - ALL PLANS	$452	Hospital’s fee	Diagnostic mammography of both breasts	percent of total billed charges	Outpatient	2026-08-31

Medicare Advantage 3 prices

Rate for a private Medicare Advantage plan. Applies only to members of that plan.

Medicare Advantage prices for Mammogram (both breasts) at Summit Pacific Medical Center
Payer	Plan	Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
CHPW MCR ADV	CHPW MCR ADV	$145	Hospital’s fee	Diagnostic mammography of both breasts	percent of total billed charges	Outpatient	2026-08-31
REGENCE BS MCR ADV - ALL PLANS	REGENCE BS MCR ADV - ALL PLANS	$141	Hospital’s fee	Diagnostic mammography of both breasts	percent of total billed charges	Outpatient	2026-08-31
WELLCARE MCR ADV - ALL PLANS	WELLCARE MCR ADV - ALL PLANS	$150	Hospital’s fee	Diagnostic mammography of both breasts	percent of total billed charges	Outpatient	2026-08-31

Medicaid managed care 3 prices

Rate for an Apple Health managed-care plan. Applies only to members of that plan.

Medicaid managed care prices for Mammogram (both breasts) at Summit Pacific Medical Center
Payer	Plan	Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
AMERIGROUP MCAID - ALL PLANS	AMERIGROUP MCAID - ALL PLANS	$144	Hospital’s fee	Diagnostic mammography of both breasts	percent of total billed charges	Outpatient	2026-08-31
CHPW CHIP	CHPW CHIP	$131	Hospital’s fee	Diagnostic mammography of both breasts	percent of total billed charges	Outpatient	2026-08-31
CHPW HEALTHY OPTIONS	CHPW HEALTHY OPTIONS	$131	Hospital’s fee	Diagnostic mammography of both breasts	percent of total billed charges	Outpatient	2026-08-31

Other government program 1 price

TRICARE, VA, Indian Health Service, workers' compensation, or another public program.

Other government program prices for Mammogram (both breasts) at Summit Pacific Medical Center
Payer	Plan	Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
TRIWEST - ALL PLANS	TRIWEST - ALL PLANS	$141	Hospital’s fee	Diagnostic mammography of both breasts	percent of total billed charges	Outpatient	2026-08-31

Unknown 3 prices

The source file doesn't say which population this rate applies to.

Unknown prices for Mammogram (both breasts) at Summit Pacific Medical Center
Payer	Plan	Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
CHPW BASIC HP	CHPW BASIC HP	$131	Hospital’s fee	Diagnostic mammography of both breasts	percent of total billed charges	Outpatient	2026-08-31
CIGNA - ALL PLANS	CIGNA - ALL PLANS	$452	Hospital’s fee	Diagnostic mammography of both breasts	percent of total billed charges	Outpatient	2026-08-31
UHC ALL PAYER - ALL PLANS	UHC ALL PAYER - ALL PLANS	$480	Hospital’s fee	Diagnostic mammography of both breasts	percent of total billed charges	Outpatient	2026-08-31

Doctors here who do this procedure

7 doctors affiliated with Summit Pacific Medical Center billed Traditional Medicare for Mammogram (both breasts) in 2024, most Medicare services first. See all doctors and practices, including those with no hospital affiliation.

Doctors affiliated with Summit Pacific Medical Center who billed Traditional Medicare for Mammogram (both breasts)
Doctor or practice	Practice	Medicare quality score	Times billed to Traditional Medicare (2024)	Traditional Medicare amount for their own service (2024)
Sean Koskinen, MDDiagnostic Radiology · Richland	Oregon Healthcare Resources LLCGroup of 159 clinicians	Not rated	138	$46.20 at a hospital or surgery center
Joseph Stengel, DODiagnostic Radiology · Aberdeen	Grays Harbor Community HospitalGroup of 88 clinicians	85 of 100CMS MIPS 2024	56	$46.13 at a hospital or surgery center
Scott Zelasko, MDDiagnostic Radiology · Spokane	The Polyclinic PLLCGroup of 365 clinicians	Not rated	40	$183 in the office (no hospital amount)
Gregory Balmforth, MDDiagnostic Radiology · Spokane	The Polyclinic PLLCGroup of 365 clinicians	Not rated	39	$158 in the office (no hospital amount)
Mariam Shehata, MDDiagnostic Radiology · Seattle	The Polyclinic PLLCGroup of 365 clinicians	Not rated	38	$173 in the office (no hospital amount)
Oksana Prychyna, MDDiagnostic Radiology · Spokane	Virginia Mason Medical CenterGroup of 867 clinicians	Not rated	12	$172 in the office (no hospital amount)
Jennifer Xiao, MDDiagnostic Radiology · Spokane	Kaiser Foundation Health Plan Of WashingtonGroup of 1,526 clinicians	Not rated	11	$171 in the office (no hospital amount)

Reading the doctor list

A higher price doesn’t mean better care. The quality score and the price come from different CMS files and are shown separately on purpose.
The amount is what Traditional Medicare (original Medicare) approved for the doctor’s or lab’s own service: Medicare’s payment plus the patient’s share. It is not what commercial insurance or Medicare Advantage pays, and the hospital or surgery center bills separately (surgery centers aren’t in this list).
The Medicare quality score is CMS’s MIPS final score (0 to 100), based mostly on the doctor’s Medicare patients. About half of doctors aren’t scored, so Not rated says nothing bad about a doctor. A group’s score covers everyone in the group.
CMS doesn’t publish counts under 11 patients, so doctors who rarely bill Medicare for this aren’t listed, and No price published means CMS has no amount for that setting.
Medicare’s file doesn’t say where a doctor did the procedure, only that they billed it in Washington. Affiliations are the hospitals each doctor lists with Medicare.

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