CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Montclair Hospital Medical Center

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $100
Cash Discount Price: $99
vs. Medicare Baseline: 0.79x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Montclair Hospital Medical Center is $100. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $99. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 0.79x the Medicare baseline. Located in 5000 San Bernardino Road, Montclair, CA.

Cash / Self-Pay

$99

Average discount available for prompt cash payment at this facility.

Insurance Median

$100

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: $99 (78%)

Insurance Median: $100 (79%)

Cash: $99 (78% of Medicare)

Ins. Median: $100 (79% 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
Blue Shield Of Promise	$88	70%
Molina	$88 - $100	70%
Traditional Medi-Cal	$88	70%
Vantage Care	$88 - $100	70%
Health Net Of Ca	$95 - $146	75%
Rios	$95	75%
Alignment	$100	79%
Central Health Plan	$100	79%
Choice Physicians Network	$100	79%
Citrus Valley Physicians Group	$100	79%
Elite Health Plan	$100	79%
Emanate Health	$100 - $200	79%
Epic Health Plan	$100	79%
Inland Empire Foundation For Medical Care	$100	79%
Inland Empire Healthplan	$100 - $128	79%
Medicare (plans)	$100	79%
Renal Payor Solution	$100	79%
Tricare	$100	79%
Brand New Day	$101 - $150	80%
Neighborhood	$102	81%
Imperial Health Plan Of Ca	$106	84%
Blue Cross Blue Shield	$125	99%
Health Net Federal Services Prison (Cdcr)	$125	99%
Coventry Workers Compensation	$128	101%
Worker Compensation	$132	105%
Employer Direct Health Care	$140	111%

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 $99.
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 Montclair Hospital Medical Center 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.