CMS Price Transparency Data
Screening mammogram (both breasts)
Facility: Saint Alphonsus Medical Center Ontario
Billing Code: 77067 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 77067
- Insurance Median: $100
- Cash Discount Price: $211
- vs. Medicare Baseline: 0.79x Medicare
The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Saint Alphonsus Medical Center Ontario is $100. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $211. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 0.79x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.
Cash / Self-Pay
$211
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: $211 (167%)
Insurance Median: $100 (79%)
Cash: $211 (167% 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $85 - $100 | 67% |
| Blue Cross Blue Shield | $89 - $283 | 70% |
| Medicare (plans) | $89 - $95 | 70% |
| UnitedHealthcare | $89 - $320 | 70% |
| Aetna | $92 - $315 | 73% |
| American Health Advantage Of Idaho | $92 | 73% |
| Ada County Jail Inmate Ins | $95 - $100 | 75% |
| Ambetter / Centene | $95 - $100 | 75% |
| Amish Mennonite | $95 - $100 | 75% |
| Bcccp-Michigan | $95 - $100 | 75% |
| Bccp | $95 - $100 | 75% |
| Bmc Healthnet | $95 - $100 | 75% |
| Breast Grant-Connecticut | $95 - $100 | 75% |
| California Health And Wellness | $95 - $100 | 75% |
| Cardinal Innovations Lme | $95 - $100 | 75% |
| Care Oregon Ohp | $95 - $100 | 75% |
| Cencal Health Plan | $95 - $100 | 75% |
| Cenpatico | $95 - $100 | 75% |
| Centurion Of Idaho | $95 - $100 | 75% |
| Chhuny | $95 - $100 | 75% |
| Childrens Comm Health Plan | $95 - $100 | 75% |
| Childrens Medical Services Title 19 | $95 - $100 | 75% |
| Cigna | $95 - $313 | 75% |
| Community Benefit Health | $95 - $100 | 75% |
| Community Care Behavorial Health | $95 - $100 | 75% |
| Community Health Choice | $95 - $100 | 75% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $95 - $100 | 75% |
| Dean Wi Badgercare | $95 - $100 | 75% |
| Delaware First Health | $95 - $100 | 75% |
| Delta Dental Nj | $95 - $100 | 75% |
| Dph Tb Program | $95 - $100 | 75% |
| Dscc | $95 - $100 | 75% |
| Eastpointe Lme | $95 - $100 | 75% |
| Family Health Network | $95 - $100 | 75% |
| Freedom First Healthcare | $95 - $100 | 75% |
| Ghc Scw Wi Badgercare | $95 - $100 | 75% |
| Harbor Health | $95 - $100 | 75% |
| Health Safety Net | $95 - $100 | 75% |
| Healthy Blue Ne | $95 - $100 | 75% |
| Hennepin Health | $95 - $100 | 75% |
| Humana | $95 - $293 | 75% |
| Id County Ada | $95 - $100 | 75% |
| Id County Canyon | $95 - $100 | 75% |
| Id County Cat Fund | $95 - $100 | 75% |
| Id County Payette | $95 - $100 | 75% |
| Idaho Womens Health Check | $95 - $100 | 75% |
| Indiana Breast Cervical Cancer | $95 - $100 | 75% |
| Inland Empire Health Plan | $95 - $100 | 75% |
| Intercommunity Health Ohp | $95 - $100 | 75% |
| Iowa Total Care | $95 - $100 | 75% |
| Jai Medical System | $95 - $100 | 75% |
| Kern Family Health Plan | $95 - $100 | 75% |
| Keystone First | $95 - $100 | 75% |
| Keystone First Chip | $95 - $100 | 75% |
| La Care Health Plan | $95 - $100 | 75% |
| Lakeland Care Inc | $95 - $100 | 75% |
| Managed Health Services - Indiana | $95 - $100 | 75% |
| Maryland Breast & Cervical Program | $95 - $100 | 75% |
| Maryland Healthy Smiles - Scion Dental | $95 - $100 | 75% |
| Maryland Physicians Care | $95 - $100 | 75% |
| Massachusetts Behavioral Health Partnership | $95 - $100 | 75% |
| Mdwise | $95 - $100 | 75% |
| Medi-Cal | $95 - $100 | 75% |
| Medi-Cal Healthnet | $95 - $100 | 75% |
| Medstar Dc Healthy Family | $95 - $100 | 75% |
| Medstar Md Health Choice | $95 - $100 | 75% |
| Mo Home State Health Plan | $95 - $100 | 75% |
| Molina Centennial Care | $95 - $100 | 75% |
| Nascentia Health Options | $95 - $100 | 75% |
| Nebraska Total Care | $95 - $100 | 75% |
| New York Cancer Services Program | $95 - $100 | 75% |
| Nextlevel Health | $95 - $100 | 75% |
| Oregon Screenwise | $95 - $100 | 75% |
| Pace Of Southwest Michigan | $95 - $100 | 75% |
| Paramount Advantage | $95 - $100 | 75% |
| Parkland Community Health Plan | $95 - $100 | 75% |
| Partners Behavioral Lme | $95 - $100 | 75% |
| Peach State Healthplan | $95 - $100 | 75% |
| Presbyterian Centennial Care | $95 - $100 | 75% |
| Prestige Health Choice | $95 - $100 | 75% |
| Priority Partners | $95 - $100 | 75% |
| Rx 340B Pass Along | $95 - $100 | 75% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $95 - $100 | 75% |
| Rx Medi-Cal | $95 - $100 | 75% |
| Rx Meridian Rx | $95 - $100 | 75% |
| Sandhills Center Lme | $95 - $100 | 75% |
| Screening For Life | $95 - $100 | 75% |
| Sunshine State Health Plan | $95 - $100 | 75% |
| Superior Health | $95 - $100 | 75% |
| Tenncare | $95 - $100 | 75% |
| Texas Children'S Health Plan | $95 - $100 | 75% |
| Trillium Community Ohp | $95 - $100 | 75% |
| Tufts Health Public Plans | $95 - $100 | 75% |
| Vaya Health Lme | $95 - $100 | 75% |
| Wellsense Health Plan | $95 - $100 | 75% |
| Wi Womens Wellness | $95 - $100 | 75% |
| Blue Benefit Administrators Of Massachusetts | $145 | 115% |
| Blue Care Network | $145 | 115% |
| Blue Distinction Transplant | $145 | 115% |
| Blue Shield - Ca | $145 | 115% |
| Blue Shield - Id (Regence) | $145 | 115% |
| Blue Shield - Ny Highmark Northeastern | $145 | 115% |
| Blue Shield - Ny Highmark Western | $145 | 115% |
| Blue Shield - Pa (Highmark) | $145 | 115% |
| Blue Shield - Wa (Regence) | $145 | 115% |
| Healthcare Management Admin | $157 | 124% |
| Moda Health | $163 - $323 | 129% |
| Mountain Health Co-Op | $190 - $200 | 150% |
| Pacificsource Health Plans | $190 - $313 | 150% |
| Selecthealth | $193 - $300 | 153% |
| Allegiance | $240 - $253 | 190% |
| Webtpa | $240 - $300 | 190% |
| Correctional Health Partners | $246 - $260 | 195% |
| Columbia Health Network | $253 - $266 | 200% |
| Healthnet | $265 - $280 | 210% |
| Allied National Global Care | $284 - $300 | 225% |
| Asrm - Reliance Standard Life Insurance | $284 - $300 | 225% |
| Christian Care Ministry | $284 - $300 | 225% |
| Dean Health | $284 - $300 | 225% |
| Fallon Health | $284 - $300 | 225% |
| Family Life Insurance Company | $284 - $300 | 225% |
| First Choice Health | $284 - $300 | 225% |
| Ghc Scw | $284 - $300 | 225% |
| International Benefit Administrators | $284 - $300 | 225% |
| Lifetime Benefit Solutions | $284 - $300 | 225% |
| Manhattan Life | $284 - $300 | 225% |
| Pai | $284 - $300 | 225% |
| Pan-American Life | $284 - $300 | 225% |
| Paramount Hmo | $284 - $300 | 225% |
| Phcs | $284 - $300 | 225% |
| Trinity Health Share | $284 - $300 | 225% |
| Lifewise | $294 - $310 | 233% |
| Priority Health | $297 - $313 | 235% |
| Allied Benefit Systems | $299 - $315 | 237% |
| Ameriben | $299 - $315 | 237% |
| Asr Health Benefits | $299 - $315 | 237% |
| Christian Brother Services | $299 - $315 | 237% |
| Geha | $299 - $320 | 237% |
| Healthez | $299 - $315 | 237% |
| Luminare Health (Detroit) | $299 - $315 | 237% |
| Rural Carrier Health Benefit Plan | $299 - $315 | 237% |
| First Health | $300 - $316 | 238% |
| Medi Share | $300 - $316 | 238% |
| Providence | $300 - $316 | 238% |