CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: South Pointe Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $258
Cash Discount Price: $367
vs. Medicare Baseline: 2.04x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at South Pointe Hospital is $258. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $367. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 2.04x the Medicare baseline. Located in 20000 Harvard Road, Warrensville Heights, OH.

Cash / Self-Pay

$367

Average discount available for prompt cash payment at this facility.

Insurance Median

$258

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: $367 (291%)

Insurance Median: $258 (204%)

Cash: $367 (291% of Medicare)

Ins. Median: $258 (204% 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 204% of the Medicare baseline (a markup of 104%). 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
UnitedHealthcare	$47 - $350	37%
Paramount	$51	40%
Blue Cross Blue Shield	$52 - $451	41%
Buckeye	$52	41%
Molina	$52	41%
Caresource	$53	42%
United	$53 - $217	42%
Amerihealth	$54	43%
Aetna	$169 - $564	134%
Humana	$169 - $479	134%
Summacare	$169 - $211	134%
The Health Plan	$169 - $338	134%
Upmc	$169 - $338	134%
Valor	$169	134%
Oscar	$170 - $217	135%
Cigna	$174 - $451	138%
Perennial Health	$183	145%
Mmo	$208 - $338	165%
Cc Ehp	$225 - $228	178%
Aultcare	$243	192%
Ohcp	$274	217%
Omas	$282	223%
Ohio Healthy	$305	242%
Healthsmart	$310	246%
Php	$338	268%
Gms	$395	313%
Medical Benefit Corp	$395	313%
Quality Care Partners	$395	313%
Consociate Health	$423	335%
Frontpath	$508	402%
Managed Care Services	$508	402%
Multiplan	$508	402%
Tertiary Care Network	$508	402%
Three Rivers	$508	402%

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 $367.
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 South Pointe 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.