CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Holy Cross Hospital - Salt Lake

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $327
Cash Discount Price: $257
vs. Medicare Baseline: 2.59x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Holy Cross Hospital - Salt Lake is $327. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $257. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 2.59x the Medicare baseline. Located in 1050 East South Temple, Salt Lake City, UT.

Cash / Self-Pay

$257

Average discount available for prompt cash payment at this facility.

Insurance Median

$327

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: $257 (204%)

Insurance Median: $327 (259%)

Cash: $257 (204% of Medicare)

Ins. Median: $327 (259% 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 259% of the Medicare baseline (a markup of 159%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Denver Health	$71	56%
Health Choice	$71	56%
Medicaid / KanCare	$71	56%
Rocky Mountain Health Plan	$71	56%
Uuhp	$71 - $348	56%
Blue Cross Blue Shield	$82 - $386	65%
Humana	$82	65%
Medicare (plans)	$82	65%
Cigna	$92 - $514	73%
Employer Direct Healthcare	$103	82%
Motivhealth	$109	86%
Centura Employee Plan	$122	97%
UnitedHealthcare	$161	128%
Molina	$192 - $276	152%
Pehp	$274 - $643	217%
Aetna	$284 - $543	225%
Wise	$334 - $341	265%
Deseret Mutual Benefit Administrators	$395	313%
Select Health	$425	337%
Multiplan	$444 - $585	352%
Emi Health	$643	509%

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 $257.
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 Holy Cross Hospital - Salt Lake 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.