CMS Price Transparency Data

CT scan, pelvis

Facility: Samuel Mahelona Memorial Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72192
  • Insurance Median: $319
  • Cash Discount Price: $728
  • vs. Medicare Baseline: 2.99x Medicare
The contracted insurance negotiated median rate for a CT scan, pelvis at Samuel Mahelona Memorial Hospital is $319. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $728. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.99x the Medicare baseline. Located in 4800 Kawaihau Road, Kapaa, HI.
Cash / Self-Pay
$728

Average discount available for prompt cash payment at this facility.

Insurance Median
$319

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: $728 (682%)
Insurance Median: $319 (299%)
Cash: $728 (682% of Medicare)
Ins. Median: $319 (299% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 299% of the Medicare baseline (a markup of 199%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 $51 - $560 48%
Ohana Health Plan $51 - $560 48%
UnitedHealthcare $51 - $560 48%
Alohacare $51 - $560 48%
Devoted Health $56 - $616 52%
Kaiser Permanente $61 - $1,008 57%
Hawaii Western Management Group $107 - $319 100%
Health Management Network $168 - $952 157%
University Health Alliance $496 464%
Humana $560 524%
Mdx Hawaii $1,086 1017%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 4800 Kawaihau Road, Kapaa, HI 96746
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - State
  • Hospital Type: Critical Access Hospitals