CMS Price Transparency Data

X-ray, pelvis

Facility: Pali Momi Medical Center

Billing Code: 72170 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72170
Insurance Median: $126
Cash Discount Price: $179
vs. Medicare Baseline: 1.18x Medicare

The contracted insurance negotiated median rate for a X-ray, pelvis at Pali Momi Medical Center is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $179. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 1.18x the Medicare baseline. Located in 98-1079 Moanalua Road, Aiea, HI.

Cash / Self-Pay

$179

Average discount available for prompt cash payment at this facility.

Insurance Median

$126

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: $179 (168%)

Insurance Median: $126 (118%)

Cash: $179 (168% of Medicare)

Ins. Median: $126 (118% 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.

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	$19 - $139	18%
UnitedHealthcare	$19	18%
Hmsa	$20 - $126	19%
Ohana	$20 - $151	19%
Mdx	$29 - $126	27%
Pac Admin	$32	30%
Uha	$41	38%
Hwmg/Hmaa	$56	52%
Verdegard	$65	61%
Devoted	$132	124%
Calvos	$224	210%
Mimoh	$224	210%
Hcha	$238	223%
Kaiser	$238	223%
Multiplan	$238 - $253	223%
Coventry	$253	237%
Mccp	$253	237%

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 $179.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72170.

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 72170.
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.