CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: Pali Momi Medical Center

Billing Code: 71250 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 71250
Insurance Median: $1,222
Cash Discount Price: $1,162
vs. Medicare Baseline: 11.44x Medicare

The contracted insurance negotiated median rate for a CT scan, chest (no contrast) at Pali Momi Medical Center is $1,222. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,162. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 11.44x the Medicare baseline. Located in 98-1079 Moanalua Road, Aiea, HI.

Cash / Self-Pay

$1,162

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,222

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $1,162 (1088%)

Insurance Median: $1,222 (1144%)

Cash: $1,162 (1088% of Medicare)

Ins. Median: $1,222 (1144% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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 1144% of the Medicare baseline (a markup of 1044%). 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
Alohacare	$93 - $453	87%
Ohana	$95 - $481	89%
Hmsa	$126 - $389	118%
Mdx	$126 - $1,300	118%
Devoted	$132	124%
UnitedHealthcare	$195 - $406	183%
Hwmg/Hmaa	$273 - $1,225	256%
Pac Admin	$371 - $1,138	347%
Uha	$407	381%
Verdegard	$410 - $1,300	384%
Calvos	$1,219 - $1,598	1141%
Mimoh	$1,219 - $1,598	1141%
Hcha	$1,300 - $1,705	1217%
Kaiser	$1,300 - $1,705	1217%
Multiplan	$1,300 - $1,811	1217%
Coventry	$1,381 - $1,811	1293%
Mccp	$1,381 - $1,811	1293%

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 $1,162.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 71250.

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 71250.
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.