CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Adventist Health Clearlake

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $680
Cash Discount Price: $321
vs. Medicare Baseline: 5.39x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Adventist Health Clearlake is $680. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $321. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 5.39x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$321

Average discount available for prompt cash payment at this facility.

Insurance Median

$680

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: $321 (254%)

Insurance Median: $680 (539%)

Cash: $321 (254% of Medicare)

Ins. Median: $680 (539% 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 539% of the Medicare baseline (a markup of 439%). 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
Blue Shield Mcr Adv	$143 - $246	113%
Kaiser Mcr Adv	$143 - $246	113%
Tricare	$143 - $246	113%
Blue Cross Blue Shield	$149 - $902	118%
UnitedHealthcare	$157 - $978	124%
Bc Managed Mcal	$180	143%
Medi-Cal	$180	143%
Ah Employee Health Plan - All Plans	$286 - $493	227%
Aetna	$508 - $876	402%
Western Growers- All Plans	$510 - $880	404%
Blue Shield Epn - All Other Plans	$522 - $901	413%
Blue Shield Non-Epn	$522 - $901	413%
First Health- All Plans	$544 - $938	431%
Healthnet- All Plans	$558 - $962	442%
Foundation- All Plans	$578 - $997	458%
Health Mgmt Network- All Plans	$578 - $997	458%
Humana	$578 - $997	458%
Phcs- All Plans	$578 - $997	458%
Cigna	$612 - $1,056	485%
Interplan- All Plans	$612 - $1,056	485%
Kaiser- All Other Plans	$612 - $1,056	485%
Three Rivers Provider Network- All Plans	$612 - $1,056	485%
Partnership Mcal - All Plans	$1,122 - $1,935	889%

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 $321.
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 Clearlake 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.