CMS Price Transparency Data

CT scan, abdomen and pelvis (with contrast)

Facility: Samuel Mahelona Memorial Hospital

Billing Code: 74177 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 74177
Insurance Median: $364
Cash Discount Price: $2,287
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a CT scan, abdomen and pelvis (with contrast) at Samuel Mahelona Memorial Hospital is $364. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,287. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 1.02x the Medicare baseline. Located in 4800 Kawaihau Road, Kapaa, HI.

Cash / Self-Pay

$2,287

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

$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)

Cash / Self-Pay: $2,287 (642%)

Insurance Median: $364 (102%)

Cash: $2,287 (642% of Medicare)

Ins. Median: $364 (102% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $356.43 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	$85 - $5,102	24%
Hawaii Medical Service Association	$85 - $5,102	24%
Alohacare	$85 - $5,102	24%
Ohana Health Plan	$85 - $5,102	24%
Devoted Health	$94 - $5,613	26%
Kaiser Permanente	$102 - $9,184	29%
Hawaii Western Management Group	$356 - $393	100%
Health Management Network	$413 - $8,674	116%
University Health Alliance	$728	204%
Humana	$1,759 - $5,102	494%
Mdx Hawaii	$3,412 - $9,899	957%

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 $2,287.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 74177.

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 74177.
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.