CMS Price Transparency Data

Diagnostic mammogram (both breasts)

Facility: South Pointe Hospital

Billing Code: 77066 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77066
Insurance Median: $300
Cash Discount Price: $425
vs. Medicare Baseline: 1.91x Medicare

The contracted insurance negotiated median rate for a Diagnostic mammogram (both breasts) at South Pointe Hospital is $300. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $425. Compared to the federal Medicare reimbursement reference rate of $156.98, this hospital’s rate is 1.91x the Medicare baseline. Located in 20000 Harvard Road, Warrensville Heights, OH.

Cash / Self-Pay

$425

Average discount available for prompt cash payment at this facility.

Insurance Median

$300

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$156.98

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $156.98 (100%)

Cash / Self-Pay: $425 (271%)

Insurance Median: $300 (191%)

Cash: $425 (271% of Medicare)

Ins. Median: $300 (191% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $156.98 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
UnitedHealthcare	$47 - $405	30%
Paramount	$51	32%
Blue Cross Blue Shield	$52 - $523	33%
Buckeye	$52	33%
Molina	$52	33%
Caresource	$53	34%
United	$53 - $263	34%
Amerihealth	$54	34%
Oscar	$197 - $251	125%
Aetna	$208 - $654	133%
Humana	$208 - $556	133%
Summacare	$208 - $245	133%
The Health Plan	$208 - $392	133%
Upmc	$208 - $392	133%
Valor	$208	133%
Cigna	$214 - $523	136%
Perennial Health	$225	143%
Mmo	$234 - $392	149%
Cc Ehp	$261 - $265	166%
Aultcare	$281	179%
Ohcp	$318	203%
Omas	$327	208%
Ohio Healthy	$353	225%
Healthsmart	$360	229%
Php	$392	250%
Gms	$458	292%
Medical Benefit Corp	$458	292%
Quality Care Partners	$458	292%
Consociate Health	$490	312%
Frontpath	$589	375%
Managed Care Services	$589	375%
Multiplan	$589	375%
Tertiary Care Network	$589	375%
Three Rivers	$589	375%

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 $425.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 77066.

Insurance In-Network Protection Plan

Contact your insurance company to confirm South Pointe Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 77066.
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.