CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Decatur Memorial Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $116
Cash Discount Price: $604
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Decatur Memorial Hospital is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $604. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 0.92x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$604

Average discount available for prompt cash payment at this facility.

Insurance Median

$116

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: $604 (478%)

Insurance Median: $116 (92%)

Cash: $604 (478% of Medicare)

Ins. Median: $116 (92% 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.

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	$30 - $61	24%
Blue Cross Blue Shield	$37 - $604	29%
Aetna	$40 - $405	32%
Coventry	$40 - $362	32%
Health Alliance	$40 - $402	32%
Humana	$40 - $393	32%
Medicare (plans)	$40 - $116	32%
UnitedHealthcare	$40 - $604	32%
Veterans Administration	$40 - $116	32%
Wellcare	$40 - $80	32%
Tricare	$41 - $119	32%
Caterpillar	$51 - $102	40%
Plain Church Medical Group	$77 - $272	61%
Mennonite Churches	$211	167%
Health Alliance Mh Employee Plan	$278	220%
Cigna	$281	223%
Hfn	$302 - $453	239%
Commercial Workers Compensation	$305	242%
Illinois Workers Compensation	$321	254%
6 Degrees Health	$362	287%
Hopetrust	$362	287%
Hst	$362	287%
Phcs Savility	$393	311%
Phcs Multiplan Ppo	$411	326%
Healthlink	$414	328%
Corvel	$435	345%
Consociate	$447	354%
Liability	$604	478%

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 $604.
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 Decatur Memorial 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.