CMS Price Transparency Data

CT scan, abdomen and pelvis (no contrast)

Facility: Samuel Mahelona Memorial Hospital

Billing Code: 74176 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74176
Insurance Median: $304
Cash Discount Price: $1,775
vs. Medicare Baseline: 1.25x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (no contrast) at Samuel Mahelona Memorial Hospital is $304. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,775. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 1.25x the Medicare baseline. Located in 4800 Kawaihau Road, Kapaa, HI.

Cash / Self-Pay

$1,775

Average discount available for prompt cash payment at this facility.

Insurance Median

$304

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: $1,775 (728%)

Insurance Median: $304 (125%)

Cash: $1,775 (728% of Medicare)

Ins. Median: $304 (125% 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
Hawaii Medical Service Association	$81 - $4,418	33%
Alohacare	$81 - $4,418	33%
UnitedHealthcare	$81 - $4,418	33%
Ohana Health Plan	$81 - $4,418	33%
Devoted Health	$89 - $4,860	37%
Kaiser Permanente	$98 - $7,952	40%
Hawaii Western Management Group	$244 - $246	100%
Health Management Network	$261 - $7,511	107%
University Health Alliance	$454	186%
Humana	$1,365 - $4,418	560%
Mdx Hawaii	$2,648 - $8,571	1086%

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 $1,775.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74176.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Samuel Mahelona Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 74176.
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.