CMS Price Transparency Data

X-ray, shoulder

Facility: Pali Momi Medical Center

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $146
Cash Discount Price: $221
vs. Medicare Baseline: 1.64x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Pali Momi Medical Center is $146. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $221. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 1.64x the Medicare baseline. Located in 98-1079 Moanalua Road, Aiea, HI.

Cash / Self-Pay

$221

Average discount available for prompt cash payment at this facility.

Insurance Median

$146

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$88.91

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $88.91 (100%)

Cash / Self-Pay: $221 (249%)

Insurance Median: $146 (164%)

Cash: $221 (249% of Medicare)

Ins. Median: $146 (164% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $88.91 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
UnitedHealthcare	$19 - $123	21%
Hmsa	$21 - $104	24%
Alohacare	$24 - $137	27%
Ohana	$25 - $146	28%
Pac Admin	$36 - $345	40%
Mdx	$38 - $394	43%
Hwmg/Hmaa	$47 - $372	53%
Uha	$47	53%
Verdegard	$69 - $394	78%
Devoted	$110	124%
Calvos	$268 - $370	301%
Mimoh	$268 - $370	301%
Hcha	$286 - $394	322%
Kaiser	$286 - $394	322%
Multiplan	$286 - $419	322%
Coventry	$304 - $419	342%
Mccp	$304 - $419	342%

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 $221.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 73030.

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 73030.
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.