Summit Pacific Medical Center

ElmaGrays Harbor CountyCritical Access Hospitals

Screening mammogram

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: $422 to $509Depends on your plan. Each plan’s price at this hospital:
FIRST CHOICE - ALL PLANS $422 Higher than typical
AETNA COMM - ALL PLANS $475 Higher than typical
CHPW PEBB - ALL OTHER PLANS $509 Higher than typical
Typical at 36 hospitals we cover: $165 to $263 (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): $385 TypicalTypical hospital’s fee at 34 hospitals we cover: $270 to $396.Hospital’s fee $285 + radiologist’s fee $99.90, both billed by the hospital.

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).

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

Cash price 2 prices

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

Cash price prices for Screening mammogram at Summit Pacific Medical Center
Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
$285	Hospital’s fee	Screening mammography	—	Outpatient	2026-08-31
$99.90	Radiologist’s fee	Screening mammography	—	Outpatient	2026-08-31

List price (before discounts) 2 prices

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

List price (before discounts) prices for Screening mammogram at Summit Pacific Medical Center
Price	Part of the bill	Hospital’s description	How it’s set	Setting	Source date
$528	Hospital’s fee	Screening mammography	—	Outpatient	2026-08-31
$185	Radiologist’s fee	Screening mammography	—	Outpatient	2026-08-31

Commercial insurance 4 prices

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

Commercial insurance prices for Screening mammogram 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	$475	Hospital’s fee	Screening mammography	percent of total billed charges	Outpatient	2026-08-31
CHPW PEBB - ALL OTHER PLANS	CHPW PEBB - ALL OTHER PLANS	$370	Hospital’s fee	Screening mammography	percent of total billed charges	Outpatient	2026-08-31
CHPW PEBB - ALL OTHER PLANS	CHPW PEBB - ALL OTHER PLANS	$139	Radiologist’s fee	Screening mammography	fee schedule	Outpatient	2026-08-31
FIRST CHOICE - ALL PLANS	FIRST CHOICE - ALL PLANS	$422	Hospital’s fee	Screening mammography	percent of total billed charges	Outpatient	2026-08-31

Medicare Advantage 6 prices

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

Medicare Advantage prices for Screening mammogram 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	$136	Hospital’s fee	Screening mammography	percent of total billed charges	Outpatient	2026-08-31
CHPW MCR ADV	CHPW MCR ADV	$35.55	Radiologist’s fee	Screening mammography	fee schedule	Outpatient	2026-08-31
REGENCE BS MCR ADV - ALL PLANS	REGENCE BS MCR ADV - ALL PLANS	$132	Hospital’s fee	Screening mammography	percent of total billed charges	Outpatient	2026-08-31
REGENCE BS MCR ADV - ALL PLANS	REGENCE BS MCR ADV - ALL PLANS	$36.26	Radiologist’s fee	Screening mammography	fee schedule	Outpatient	2026-08-31
WELLCARE MCR ADV - ALL PLANS	WELLCARE MCR ADV - ALL PLANS	$140	Hospital’s fee	Screening mammography	percent of total billed charges	Outpatient	2026-08-31
WELLCARE MCR ADV - ALL PLANS	WELLCARE MCR ADV - ALL PLANS	$37.68	Radiologist’s fee	Screening mammography	fee schedule	Outpatient	2026-08-31

Medicaid managed care 6 prices

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

Medicaid managed care prices for Screening mammogram 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	$134	Hospital’s fee	Screening mammography	percent of total billed charges	Outpatient	2026-08-31
AMERIGROUP MCAID - ALL PLANS	AMERIGROUP MCAID - ALL PLANS	$84.91	Radiologist’s fee	Screening mammography	fee schedule	Outpatient	2026-08-31
CHPW CHIP	CHPW CHIP	$122	Hospital’s fee	Screening mammography	percent of total billed charges	Outpatient	2026-08-31
CHPW CHIP	CHPW CHIP	$77.19	Radiologist’s fee	Screening mammography	fee schedule	Outpatient	2026-08-31
CHPW HEALTHY OPTIONS	CHPW HEALTHY OPTIONS	$122	Hospital’s fee	Screening mammography	percent of total billed charges	Outpatient	2026-08-31
CHPW HEALTHY OPTIONS	CHPW HEALTHY OPTIONS	$77.19	Radiologist’s fee	Screening mammography	fee schedule	Outpatient	2026-08-31

Other government program 2 prices

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

Other government program prices for Screening mammogram 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	$132	Hospital’s fee	Screening mammography	percent of total billed charges	Outpatient	2026-08-31
TRIWEST - ALL PLANS	TRIWEST - ALL PLANS	$35.55	Radiologist’s fee	Screening mammography	fee schedule	Outpatient	2026-08-31

Unknown 5 prices

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

Unknown prices for Screening mammogram 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	$122	Hospital’s fee	Screening mammography	percent of total billed charges	Outpatient	2026-08-31
CHPW BASIC HP	CHPW BASIC HP	$77.19	Radiologist’s fee	Screening mammography	fee schedule	Outpatient	2026-08-31
CIGNA - ALL PLANS	CIGNA - ALL PLANS	$422	Hospital’s fee	Screening mammography	percent of total billed charges	Outpatient	2026-08-31
UHC ALL PAYER - ALL PLANS	UHC ALL PAYER - ALL PLANS	$449	Hospital’s fee	Screening mammography	percent of total billed charges	Outpatient	2026-08-31
UHC ALL PAYER - ALL PLANS	UHC ALL PAYER - ALL PLANS	$49.25	Radiologist’s fee	Screening mammography	fee schedule	Outpatient	2026-08-31

Doctors here who do this procedure

8 doctors affiliated with Summit Pacific Medical Center billed Traditional Medicare for Screening mammogram 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 Screening mammogram
Doctor or practice	Practice	Medicare quality score	Times billed to Traditional Medicare (2024)	Traditional Medicare amount for their own service (2024)
Mariam Shehata, MDDiagnostic Radiology · Seattle	The Polyclinic PLLCGroup of 365 clinicians	Not rated	2,892	$37.72 at a hospital or surgery center
Scott Zelasko, MDDiagnostic Radiology · Spokane	The Polyclinic PLLCGroup of 365 clinicians	Not rated	2,860	$37.65 at a hospital or surgery center
Gurpreet Dhillon, MDDiagnostic Radiology · Spokane	The Polyclinic PLLCGroup of 365 clinicians	Not rated	1,689	$37.62 at a hospital or surgery center
Oksana Prychyna, MDDiagnostic Radiology · Spokane	Virginia Mason Medical CenterGroup of 867 clinicians	Not rated	1,646	$37.72 at a hospital or surgery center
Gregory Balmforth, MDDiagnostic Radiology · Spokane	The Polyclinic PLLCGroup of 365 clinicians	Not rated	1,591	$35.09 at a hospital or surgery center
Sean Koskinen, MDDiagnostic Radiology · Richland	Oregon Healthcare Resources LLCGroup of 159 clinicians	Not rated	1,512	$35.07 at a hospital or surgery center
Jennifer Xiao, MDDiagnostic Radiology · Spokane	Kaiser Foundation Health Plan Of WashingtonGroup of 1,526 clinicians	Not rated	1,107	$37.67 at a hospital or surgery center
Joseph Stengel, DODiagnostic Radiology · Aberdeen	Grays Harbor Community HospitalGroup of 88 clinicians	85 of 100CMS MIPS 2024	644	$35.07 at a hospital or surgery center

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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