CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Pali Momi Medical Center

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $2,538
Cash Discount Price: $2,354
vs. Medicare Baseline: 7.12x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Pali Momi Medical Center is $2,538. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,354. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 7.12x the Medicare baseline. Located in 98-1079 Moanalua Road, Aiea, HI.

Cash / Self-Pay

$2,354

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,538

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)

Cash / Self-Pay: $2,354 (660%)

Insurance Median: $2,538 (712%)

Cash: $2,354 (660% of Medicare)

Ins. Median: $2,538 (712% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $356.43 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 712% of the Medicare baseline (a markup of 612%). 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	$181	51%
Alohacare	$214 - $466	60%
Ohana	$220 - $508	62%
Mdx	$331 - $423	93%
Hmsa	$423 - $901	119%
Devoted	$445	125%
Hwmg/Hmaa	$538	151%
Verdegard	$760	213%
Pac Admin	$2,292 - $2,787	643%
Calvos	$2,456 - $2,986	689%
Mimoh	$2,456 - $2,986	689%
Hcha	$2,620 - $3,185	735%
Kaiser	$2,620 - $3,185	735%
Multiplan	$2,620 - $3,384	735%
Coventry	$2,784 - $3,384	781%
Mccp	$2,784 - $3,384	781%

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 $2,354.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74177.

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 74177.
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.