CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: Samuel Mahelona Memorial Hospital

Billing Code: 71250 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 71250
Insurance Median: $285
Cash Discount Price: $1,047
vs. Medicare Baseline: 2.67x Medicare

The contracted insurance negotiated median rate for a CT scan, chest (no contrast) at Samuel Mahelona Memorial Hospital is $285. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,047. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.67x the Medicare baseline. Located in 4800 Kawaihau Road, Kapaa, HI.

Cash / Self-Pay

$1,047

Average discount available for prompt cash payment at this facility.

Insurance Median

$285

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: $1,047 (980%)

Insurance Median: $285 (267%)

Cash: $1,047 (980% of Medicare)

Ins. Median: $285 (267% 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 267% of the Medicare baseline (a markup of 167%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$50 - $2,374	47%
Hawaii Medical Service Association	$50 - $2,374	47%
Alohacare	$50 - $2,374	47%
Ohana Health Plan	$50 - $2,374	47%
Devoted Health	$55 - $2,611	51%
Kaiser Permanente	$60 - $4,272	56%
Hawaii Western Management Group	$107 - $323	100%
Health Management Network	$158 - $4,035	148%
University Health Alliance	$502	470%
Humana	$805 - $2,374	754%
Mdx Hawaii	$1,562 - $4,605	1462%

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 $1,047.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 71250.

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 71250.
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.