CMS Price Transparency Data
Screening mammogram (both breasts)
Facility: Saint Joseph Regional Medical Center - Plymouth
Billing Code: 77067 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 77067
- Insurance Median: $294
- Cash Discount Price: $278
- vs. Medicare Baseline: 2.33x Medicare
The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Saint Joseph Regional Medical Center - Plymouth is $294. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $278. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 2.33x the Medicare baseline. Located in 1915 Lake Ave, Plymouth, IN.
Cash / Self-Pay
$278
Average discount available for prompt cash payment at this facility.
Insurance Median
$294
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: $278 (220%)
Insurance Median: $294 (233%)
Cash: $278 (220% of Medicare)
Ins. Median: $294 (233% 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 233% of the Medicare baseline (a markup of 133%). 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 |
|---|---|---|
| Aetna | $49 - $299 | 39% |
| Blue Cross Blue Shield | $49 - $270 | 39% |
| Medicaid / KanCare | $49 - $270 | 39% |
| UnitedHealthcare | $49 - $315 | 39% |
| Medicare (plans) | $84 - $86 | 67% |
| Meridian Complete | $84 | 67% |
| Pace-Trinity Health | $84 | 67% |
| County Coroner | $88 | 70% |
| Provider Partners Health Plan Of Indiana | $93 | 74% |
| Plain Church Group | $107 - $124 | 85% |
| Auxiant | $127 - $382 | 101% |
| Physicians Health Plan Northern Indiana Health Insurance | $127 - $255 | 101% |
| St Joseph County Hlth Dpt | $127 | 101% |
| Caresource | $131 | 104% |
| Siho Insurance Services | $135 | 107% |
| Key Benefit Administrator | $152 - $323 | 120% |
| Allied Benefit Systems | $160 - $299 | 127% |
| Blue Benefit Administrators Of Massachusetts | $169 | 134% |
| Blue Care Network | $169 | 134% |
| Blue Distinction Transplant | $169 | 134% |
| Blue Shield - Ca | $169 | 134% |
| Blue Shield - Id (Regence) | $169 | 134% |
| Blue Shield - Ny Highmark Northeastern | $169 | 134% |
| Blue Shield - Ny Highmark Western | $169 | 134% |
| Blue Shield - Pa (Highmark) | $169 | 134% |
| Blue Shield - Wa (Regence) | $169 | 134% |
| Custom Design Benefits | $181 | 143% |
| Notre Dame Athletic Association | $218 - $253 | 173% |
| Wc Notre Dame | $218 - $253 | 173% |
| Luminare Health (Detroit) | $226 - $276 | 179% |
| Ameriben | $238 - $276 | 189% |
| Asr Health Benefits | $257 - $299 | 204% |
| Christian Brother Services | $257 - $299 | 204% |
| Employee Benefit Management | $257 - $299 | 204% |
| Medical Mutual | $257 - $299 | 204% |
| Meritain | $257 - $299 | 204% |
| Preferred One | $257 - $299 | 204% |
| Rural Carrier Health Benefit Plan | $257 - $299 | 204% |
| Webtpa | $257 - $299 | 204% |
| Managed Health Services - Indiana | $270 | 214% |
| Mdwise | $270 | 214% |
| Encore Health | $278 - $323 | 220% |
| Indiana Criminal Justice Inst | $278 - $323 | 220% |
| Western & Southern Financial Group | $278 - $323 | 220% |
| Cigna | $285 - $331 | 226% |
| Group Administrators | $285 - $331 | 226% |
| Health Partners | $285 - $331 | 226% |
| Mvp | $285 - $331 | 226% |
| Prairie States | $285 - $331 | 226% |
| Priority Health | $285 - $331 | 226% |
| Professional Benefit Administrators | $285 - $331 | 226% |
| Sagamore Health Network | $285 - $354 | 226% |
| Sisco Benefits | $285 - $331 | 226% |
| Unified Group Services | $285 - $331 | 226% |
| Goshen Preferred Network | $305 - $396 | 242% |
| Geha | $315 | 250% |
| Healthscope | $315 | 250% |
| Student Insurance Cma | $315 | 250% |
| Signature Care | $329 - $382 | 261% |
| Allied National Global Care | $356 - $414 | 282% |
| Asrm - Reliance Standard Life Insurance | $356 - $414 | 282% |
| Avmed Health Plan | $356 - $414 | 282% |
| Christian Care Ministry | $356 - $414 | 282% |
| Dean Health | $356 - $414 | 282% |
| Fallon Health | $356 - $414 | 282% |
| Family Life Insurance Company | $356 - $414 | 282% |
| Freedom Life Insurance Company | $356 - $414 | 282% |
| Ghc Scw | $356 - $414 | 282% |
| International Benefit Administrators | $356 - $414 | 282% |
| Lifetime Benefit Solutions | $356 - $414 | 282% |
| Manhattan Life | $356 - $414 | 282% |
| Medi Share | $356 - $414 | 282% |
| Multiplan | $356 - $414 | 282% |
| Pai | $356 - $414 | 282% |
| Pan-American Life | $356 - $414 | 282% |
| Paramount Hmo | $356 - $414 | 282% |
| Phcs | $356 - $414 | 282% |
| Philadelphia American Life Insurance | $356 - $414 | 282% |
| Trinity Health Share | $356 - $414 | 282% |
| Bankers Life Casualty | $396 - $460 | 314% |
| Bureau Of Disability | $396 - $460 | 314% |
| Wc Align Network | $396 - $460 | 314% |