CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Adventist Health Lodi Memorial

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $53
Cash Discount Price: $7
vs. Medicare Baseline: 0.42x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Adventist Health Lodi Memorial is $53. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 0.42x the Medicare baseline. Located in 975 S Fairmont Avenue, Lodi, CA.

Cash / Self-Pay

Average discount available for prompt cash payment at this facility.

Insurance Median

$53

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: $7 (6%)

Insurance Median: $53 (42%)

Cash: $7 (6% of Medicare)

Ins. Median: $53 (42% 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
Alignment Health Plan (Ahp)-All Plans	$36	29%
Blue Shield Mcare Adv	$36	29%
Healthnet Mcare	$36	29%
Hp Of San Joaquin Mcr Adv	$36	29%
Humana	$36	29%
Knnex Health - All Plans	$36	29%
Tricare	$36	29%
UnitedHealthcare	$36 - $176	29%
Hp Healthy Kids Pro Fee	$38	30%
Ah Employee Health Plan - All Plans	$39	31%
Cigna	$42	33%
First Health- All Plans	$43	34%
Beech Street- All Plans	$46	36%
Hp Of San Joaquin Ppo - All Other Plans	$46	36%
Multiplan- All Plans	$46	36%
Kaiser Commercial - All Other Plans	$48	38%
Kaiser Mcr Adv	$48	38%
Networks By Design- All Plans	$48	38%
Blue Shield Epn - All Other Plans	$50	40%
Healthnet- All Other Plans	$52	41%
Blue Shield Non-Epn	$53	42%
Western Growers- All Plans	$55	44%
Bc Mcal	$71 - $119	56%
Celtic Ins Company - All Plans	$71 - $119	56%
Healthnet Mcal	$71 - $142	56%
Hp Mcal Pro Fee	$71 - $131	56%
Hp Of San Joaquin Mcal	$71 - $142	56%
Kaiser Mcal	$71 - $119	56%
Medi-Cal	$71 - $119	56%
Blue Cross Blue Shield	$74	59%
Aetna	$139	110%

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 $7.
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 Adventist Health Lodi Memorial 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.