CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Elmhurst Hospital Center

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $164
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.30x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Elmhurst Hospital Center is $164. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 1.30x the Medicare baseline. Located in 79-01 Broadway, Elmhurst, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$164

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%)

Insurance Median: $164 (130%)

Ins. Median: $164 (130% 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
Aetna	$28 - $1,131	22%
Healthfirst	$31 - $362	25%
Amidacare	$39 - $161	31%
Emblem	$39 - $393	31%
Wellcare	$42 - $295	33%
Metroplus	$50 - $362	40%
Fidelis	$56 - $362	44%
Oscar	$58 - $270	46%
Oxford	$142 - $295	112%
United	$142 - $393	112%
Blue Cross Blue Shield	$161 - $393	128%
Carelon	$161 - $319	128%
Senior Whole Health	$161	128%
United Behavioral Health	$161 - $177	128%
Affinity	$164 - $362	130%
Carelon (Amida Care)	$164	130%
Vnsny	$164 - $417	130%
Cigna	$223 - $368	177%
Centerlight	$245	194%
Elderplan	$319	253%
Magnacare	$368	291%
Multiplan	$393	311%
Local 1199	$417	330%
Villagecare Max	$417	330%

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 $X.
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 Elmhurst Hospital Center 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.