CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Avita Ontario

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $230
Cash Discount Price: $182
vs. Medicare Baseline: 1.82x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Avita Ontario is $230. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $182. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 1.82x the Medicare baseline. Located in 715 Richland Mall, Ontario, OH.

Cash / Self-Pay

$182

Average discount available for prompt cash payment at this facility.

Insurance Median

$230

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: $182 (144%)

Insurance Median: $230 (182%)

Cash: $182 (144% of Medicare)

Ins. Median: $230 (182% 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
Medical_Mutual	$22 - $3,588	17%
Caresource	$87	69%
Medicaid / KanCare	$87	69%
Molina	$87 - $5,629	69%
Ohiorise	$87	69%
United_Healthcare	$87 - $230	69%
Blue Cross Blue Shield	$90 - $3,518	71%
Amerihealth	$92	73%
Buckeye	$95 - $3,518	75%
Humana	$95 - $3,518	75%
Cigna	$167	132%
Aetna	$182 - $3,588	144%
Medicare (plans)	$230 - $3,518	182%
Mount_Carmel	$230 - $3,518	182%

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 $182.
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 Avita Ontario 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.