CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: St Charles Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 77067
  • Insurance Median: $249
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.97x Medicare
The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at St Charles Hospital is $249. 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 1.97x the Medicare baseline. Located in 200 Belle Terre Road, Port Jefferson, NY.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$249

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: $249 (197%)
Ins. Median: $249 (197% 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
Affinity Health Plan $98 - $220 78%
Beacon Health Options $98 - $402 78%
Beacon Health Strategies $98 - $321 78%
Centerlight Healthcare $98 78%
Elderplan Inc. $98 78%
Emblem Health $98 - $402 78%
Fidelis Care New York $98 - $220 78%
Health First $98 - $220 78%
Health Plus $98 - $220 78%
Independent Health $98 78%
Medicaid / KanCare $98 78%
Mvp Health Plans $98 - $402 78%
Senior Whole Health $98 78%
UnitedHealthcare $98 - $367 78%
Self Pay $100 79%
Us Family Health Plan $185 147%
Aetna $209 - $402 166%
Surest $217 172%
Zadroga $237 188%
Centers Plan For Healthy Living $241 191%
Mail Handlers Benefit Plan $249 197%
Meritain Health $249 197%
Nippon Life Insurance Company Of America $249 197%
Salvation Army $249 197%
Blue Cross Blue Shield $278 - $402 220%
Liberty Health $321 254%
Oscar Health $329 261%
American Plan Administrators $361 286%
Amerihealth Administrators $361 286%
Benefit Services $361 286%
Ghi Cbp Ny City Employee Alternate $361 286%
International Benefit Administrator $361 286%
Ultra Benefits Inc. $361 286%
Centivo $372 - $402 295%
Apwu $402 318%
Brighton $402 - $637 318%
Cigna $402 - $522 318%
Daniel H Cook $402 318%
Nalc $402 318%
Samba $402 318%
Local 1199 $472 374%
Allied Wellfare Fund $522 413%
American Group Administrators $522 413%
Bakery & Confectionery Union $522 413%
Comprehensive Benefits Consultant $522 413%
Guardian Life Insurance Company Of America $522 413%
Maloney And Assoc $522 413%
Multiplan $522 413%
Performax $522 413%
Phcs $522 413%
Pomco $522 413%
Tpa Inc $522 413%
Unicare $522 413%
United Employees Health Plan $522 413%
Coventry $594 - $683 470%
Longevity Health Plan $642 509%
Magellan $642 509%
Galaxy $723 573%
Three Rivers Provider Network $723 573%
Aither Health $803 636%
Alpha Care $803 636%
Dentaquest $803 636%
Veterans Affairs $803 636%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 200 Belle Terre Road, Port Jefferson, NY 11777
  • CMS Rating: ★★★★★
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals