CMS Price Transparency Data

Diagnostic mammogram (both breasts)

Facility: Ascension St John Medical Center

Billing Code: 77066 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 77066
  • Insurance Median: $101
  • Cash Discount Price: $209
  • vs. Medicare Baseline: 0.64x Medicare
The contracted insurance negotiated median rate for a Diagnostic mammogram (both breasts) at Ascension St John Medical Center is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $209. Compared to the federal Medicare reimbursement reference rate of $156.98, this hospital’s rate is 0.64x the Medicare baseline. Located in 1923 South Utica Avenue, Tulsa, OK.
Cash / Self-Pay
$209

Average discount available for prompt cash payment at this facility.

Insurance Median
$101

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$156.98

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $156.98 (100%)
Cash / Self-Pay: $209 (133%)
Insurance Median: $101 (64%)
Cash: $209 (133% of Medicare)
Ins. Median: $101 (64% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $156.98 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
Champva $96 61%
Community Care - St John Network Senior - Govt $96 61%
Communitycare Senior $96 61%
Life Pace $96 61%
Longevity Health Plan Of Oklahoma $96 61%
Medicare (plans) $96 61%
UnitedHealthcare $96 - $386 61%
Va Community Care Network $96 61%
Veterans Administration $96 61%
Humana $97 62%
Blue Cross Blue Shield $101 - $304 64%
Communitycare (Standard) $106 68%
Community Care (Select) 7/1/13 $116 74%
Aetna $122 78%
Ccl&H $125 80%
Smarthealth $135 86%
Community Care Smarthealth $145 - $232 92%
Communitycare (Select) $145 - $222 92%
Connect Health Benefit $193 123%
Evolutions $193 123%
Kempton Group Administrators $217 138%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1923 South Utica Avenue, Tulsa, OK 74104
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals