CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Pinckneyville Community Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $261
Cash Discount Price: $445
vs. Medicare Baseline: 2.07x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Pinckneyville Community Hospital is $261. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $445. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 2.07x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$445

Average discount available for prompt cash payment at this facility.

Insurance Median

$261

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: $445 (352%)

Insurance Median: $261 (207%)

Cash: $445 (352% of Medicare)

Ins. Median: $261 (207% 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 207% of the Medicare baseline (a markup of 107%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Umwa Mcr Adv - All Plans	$35 - $218	28%
UnitedHealthcare	$35 - $484	28%
Wellcare Mcr Adv - All Plans	$35 - $218	28%
Aetna	$36 - $531	29%
Humana	$36 - $218	29%
Cigna	$42 - $487	33%
Blue Cross Blue Shield	$84 - $425	67%
Healthlink Hmo	$186 - $463	147%
Healthlink Ppo - All Other Plans	$186 - $487	147%
Phcs Savility	$255 - $502	202%
Ambetter / Centene	$261 - $300	207%
Medicaid / KanCare	$261 - $300	207%
Multiplan - All Plans	$270 - $531	214%
Phcs - All Other Plans	$270 - $484	214%
Healthlink Work Comp	$487	386%

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 $445.
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 Pinckneyville Community 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.