CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Pali Momi Medical Center

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74176
Insurance Median: $1,729
Cash Discount Price: $1,967
vs. Medicare Baseline: 7.09x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Pali Momi Medical Center is $1,729. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,967. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 7.09x the Medicare baseline. Located in 98-1079 Moanalua Road, Aiea, HI.

Cash / Self-Pay

$1,967

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,729

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $1,967 (807%)

Insurance Median: $1,729 (709%)

Cash: $1,967 (807% of Medicare)

Ins. Median: $1,729 (709% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 709% of the Medicare baseline (a markup of 609%). 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	$95	39%
Alohacare	$126 - $315	52%
Ohana	$130 - $344	53%
Mdx	$157 - $287	64%
Hwmg/Hmaa	$277	114%
Hmsa	$287 - $760	118%
Devoted	$301	123%
Verdegard	$421	173%
Pac Admin	$1,562 - $2,329	641%
Calvos	$1,673 - $2,495	686%
Mimoh	$1,673 - $2,495	686%
Hcha	$1,785 - $2,662	732%
Kaiser	$1,785 - $2,662	732%
Multiplan	$1,785 - $2,828	732%
Coventry	$1,896 - $2,828	778%
Mccp	$1,896 - $2,828	778%

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 $1,967.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74176.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Pali Momi Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 74176.
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.