CMS Price Transparency Data

Diagnostic mammogram (both breasts)

Facility: Samuel Mahelona Memorial Hospital

Billing Code: 77066 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77066
Insurance Median: $304
Cash Discount Price: $521
vs. Medicare Baseline: 1.94x Medicare

The contracted insurance negotiated median rate for a Diagnostic mammogram (both breasts) at Samuel Mahelona Memorial Hospital is $304. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $521. Compared to the federal Medicare reimbursement reference rate of $156.98, this hospital’s rate is 1.94x the Medicare baseline. Located in 4800 Kawaihau Road, Kapaa, HI.

Cash / Self-Pay

$521

Average discount available for prompt cash payment at this facility.

Insurance Median

$304

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: $521 (332%)

Insurance Median: $304 (194%)

Cash: $521 (332% of Medicare)

Ins. Median: $304 (194% 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
Alohacare	$47 - $512	30%
UnitedHealthcare	$47 - $512	30%
Ohana Health Plan	$47 - $512	30%
Hawaii Medical Service Association	$47 - $512	30%
Devoted Health	$52 - $563	33%
Kaiser Permanente	$57 - $921	36%
Health Management Network	$117 - $870	75%
Hawaii Western Management Group	$162 - $972	103%
University Health Alliance	$353	225%
Humana	$401 - $512	255%
Mdx Hawaii	$778 - $992	496%

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 $521.
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 Samuel Mahelona Memorial 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.