CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: HSHS St Elizabeth's Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 77067
  • Insurance Median: $414
  • Cash Discount Price: $393
  • vs. Medicare Baseline: 3.28x Medicare
The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at HSHS St Elizabeth's Hospital is $414. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $393. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 3.28x the Medicare baseline. Located in One St Elizabeth Boulevard, O Fallon, IL.
Cash / Self-Pay
$393

Average discount available for prompt cash payment at this facility.

Insurance Median
$414

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: $393 (311%)
Insurance Median: $414 (328%)
Cash: $393 (311% of Medicare)
Ins. Median: $414 (328% 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 328% of the Medicare baseline (a markup of 228%). 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
Molina Healthcare $22 - $678 17%
Meridian Health Plan $23 - $46 18%
Aetna $74 - $678 59%
Blue Cross Blue Shield $74 - $678 59%
Clear Spring Health Of Illinois $74 - $678 59%
Health Alliance Medical Plans $74 - $678 59%
Health Partners $74 - $678 59%
Humana $74 - $678 59%
UnitedHealthcare $74 - $678 59%
Sae Hospice $82 - $678 65%
Illinois Breast And Cervical Cancer Program $92 73%
Amish Community $116 - $190 92%
Celtic Insurance Company $175 - $678 139%
Naphcare $184 - $678 146%
Claim Doc $205 - $678 162%
Hopetrust $205 - $678 162%
Wellfirst $267 - $437 211%
First Health $308 - $504 244%
Cigna $327 - $678 259%
Healthlink $329 - $678 261%
Caterpillar, Inc. $332 - $544 263%
Consociate Group $364 - $597 288%
Choicecare $373 - $610 295%
Healthcare Finest Network (Hfn) $373 - $610 295%
Multiplan/Phcs $373 - $610 295%
Provider Network Of America $373 - $610 295%
City Of Springfield $414 - $678 328%
Current Health Solutions $414 - $678 328%
Healthscope $414 - $678 328%
Interplan $414 - $678 328%
Live360 $414 - $678 328%
Wexford $414 - $678 328%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: One St Elizabeth Boulevard, O Fallon, IL 62269
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals