CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Charlevoix Area Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $160
Cash Discount Price: $290
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Charlevoix Area Hospital is $160. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $290. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 1.27x the Medicare baseline. Located in 14700 Lakeshore Drive, Charlevoix, MI.

Cash / Self-Pay

$290

Average discount available for prompt cash payment at this facility.

Insurance Median

$160

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: $290 (230%)

Insurance Median: $160 (127%)

Cash: $290 (230% of Medicare)

Ins. Median: $160 (127% 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 Cross Blue Shield	$23 - $315	18%
Mclaren Health Plan	$23 - $317	18%
Meridian	$23 - $83	18%
Priority Health	$23 - $341	18%
UnitedHealthcare	$23 - $296	18%
Aetna	$34 - $308	27%
Blue Care Network	$34 - $160	27%
Hap (Health Alliance Plan)	$34 - $273	27%
Medicare (plans)	$34 - $160	27%
Michigan Amish Medical Board	$34 - $160	27%
Molina	$34 - $173	27%
Northern Michigan Mennonite Group	$34 - $160	27%
Asr Physicians Care Network	$52 - $273	41%
Cigna	$54 - $341	43%
Nomi Health	$55 - $317	44%
Employee Benefits Logistics	$59 - $272	47%
Provider Network Of America/Hma Group Health	$165 - $290	131%
Hospice Of Michigan	$205	162%
Enterprise Group Planning Employee Benefit Plan	$273	216%
First Health/Coventry Health/Community Care Network	$273	216%
Medical Cost Savings Solution	$273	216%
Three Rivers Provider Network	$290	230%
Iba Health And Life Assurance Company	$314	249%
Cofinity	$317	251%
Preferred Medical Claim Solutions	$324	257%

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 $290.
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 Charlevoix Area 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.