CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Paradise Valley Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $109
Cash Discount Price: $108
vs. Medicare Baseline: 0.86x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Paradise Valley Hospital is $109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $108. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 0.86x the Medicare baseline. Located in 2400 East 4Th St, National City, CA.

Cash / Self-Pay

$108

Average discount available for prompt cash payment at this facility.

Insurance Median

$109

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: $108 (86%)

Insurance Median: $109 (86%)

Cash: $108 (86% of Medicare)

Ins. Median: $109 (86% 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	$88 - $139	70%
Blue Sheid Of Promise	$88	70%
County Of San Diego	$88	70%
Golden Physicians Medical Group	$88 - $136	70%
Health Excel Ins	$88 - $109	70%
Heritage Provider Netwrok	$88 - $141	70%
Molina	$88 - $109	70%
Traditional Medi-Cal	$88	70%
UnitedHealthcare	$88 - $168	70%
Health Net Of Ca	$95 - $159	75%
Community Health Group	$106 - $109	84%
Blue Shield Of Ca, Va	$109	86%
Ca Foundation For Medical Care	$109	86%
Central Health	$109	86%
Choice Physicians Network	$109	86%
Clever Care Of Golden State, Inc	$109	86%
Managed Health Network	$109	86%
Medicare (plans)	$109	86%
Renal Payer Solutions	$109	86%
Tricare	$109	86%
Usa Senior Care Network	$109	86%
Verda Health Plan	$109	86%
Brand New Day	$110 - $163	87%
Imperial Health Plan Of Ca	$115	91%
Health Net Federal Service (Cdcr)	$136	108%
Veterans Evaluation Services	$136	108%
Worker Comp	$143	113%
Integrated Medical Solutions	$144	114%
Ca Dept Of Correction & Rehab	$152	120%
Employer Direct Healthcare	$152	120%
Naphcare	$169 - $218	134%
Scripps Health	$185	147%

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 $108.
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 Paradise Valley Hospital 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.