CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Pali Momi Medical Center

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $364
Cash Discount Price: $1,510
vs. Medicare Baseline: 1.49x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Pali Momi Medical Center is $364. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,510. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 1.49x the Medicare baseline. Located in 98-1079 Moanalua Road, Aiea, HI.

Cash / Self-Pay

$1,510

Average discount available for prompt cash payment at this facility.

Insurance Median

$364

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: $1,510 (619%)

Insurance Median: $364 (149%)

Cash: $1,510 (619% of Medicare)

Ins. Median: $364 (149% 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.

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	$134 - $315	55%
Ohana	$138 - $344	57%
Mdx	$187 - $287	77%
Hmsa	$287 - $818	118%
Devoted	$301	123%
Hwmg/Hmaa	$364	149%
UnitedHealthcare	$440	180%
Verdegard	$550	226%
Pac Admin	$670	275%
Uha	$729	299%
Calvos	$1,888	775%
Mimoh	$1,888	775%
Hcha	$2,014	826%
Kaiser	$2,014	826%
Multiplan	$2,014 - $2,139	826%
Coventry	$2,139	877%
Mccp	$2,139	877%

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 $1,510.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72148.

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 72148.
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.