CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Salem Memorial District Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 77067
  • Insurance Median: $214
  • Cash Discount Price: $197
  • vs. Medicare Baseline: 1.70x Medicare
The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Salem Memorial District Hospital is $214. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $197. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 1.70x the Medicare baseline. Located in Po Box 774, Salem, MO.
Cash / Self-Pay
$197

Average discount available for prompt cash payment at this facility.

Insurance Median
$214

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: $197 (156%)
Insurance Median: $214 (170%)
Cash: $197 (156% of Medicare)
Ins. Median: $214 (170% 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.

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 $54 - $307 43%
Ambetter / Centene $54 - $116 43%
Blue Cross Blue Shield $54 - $324 43%
Humana $54 - $290 43%
Tricare $54 - $116 43%
Triwest $54 - $116 43%
UnitedHealthcare $54 - $116 43%
Veteran'S Affairs $54 - $116 43%
Healthlink $102 - $222 81%
First Health $126 - $273 100%
Mercy - C.B. Management Company/Joplin Supply Company $126 - $273 100%
Mercy - City Of Springfield $126 - $273 100%
Mercy - Clayco $126 - $273 100%
Mercy - Commerce Bank $126 - $273 100%
Mercy - Diversified Plastics $126 - $273 100%
Mercy - Employers Benefit Alliance $126 - $273 100%
Mercy - Evolutions $126 - $273 100%
Mercy - Fabick Cat $126 - $273 100%
Mercy - Firsthealth Network $126 - $273 100%
Mercy - Health Management Network $126 - $273 100%
Mercy - Health Systems Inc $126 - $273 100%
Mercy - Liberty Utilities/Empire District Electric $126 - $273 100%
Mercy - Life Church $126 - $273 100%
Mercy - Missouri State University $126 - $273 100%
Mercy - Prime Health Services $126 - $273 100%
Mercy - Quiktrip Corporation $126 - $273 100%
Mercy - Shinesolar $126 - $273 100%
Mercy - Springfield Public Schools $126 - $273 100%
Mercy - Springfield Remanufacturing $126 - $273 100%
Mercy - Sumnerone $126 - $273 100%
Mercy - Trailiner $126 - $273 100%
Mercy - Walmart Mercy Accountable Care Plan $126 - $273 100%
Mercy-American Healthcare Alliance $126 - $273 100%
Phcs $126 - $290 100%
Cigna $134 - $290 106%
Mercy - Compresults $142 - $307 112%
Mercy - Corvel Corporation $142 - $307 112%
Mercy - Novasys $142 - $307 112%
Mercy - Scurlock Industries $142 - $307 112%
Mercy - Usa Managed Care Organization $142 - $307 112%
Right Choice-Alliance $150 - $324 119%
Right Choice-Regular $153 - $331 121%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: Po Box 774, Salem, MO 65560
  • CMS Rating: ★★★★☆
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Critical Access Hospitals