CT abdomen and pelvis with contrast at Samuel Mahelona Memorial Hospital. CPT 74177.
What Samuel Mahelona Memorial Hospital publishes for this service, straight from its standard-charges file, last updated June 15, 2026.
Outpatient / ER
$316cash price (self-pay)
$1,084list price
$85.17–$9,899range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Hawaii Medical Service Association | ABD | $181 |
| AlohaCare | Medicaid | $208 |
| Ohana Health Plan | Medicaid | $208 |
| UnitedHealthcare | Medicaid | $208 |
| Kaiser Permanente | Commercial | $266 |
| Hawaii Medical Service Association | Medicare | $285 |
| Kaiser Permanente | Medicare | $285 |
| UnitedHealthcare | Medicare | $285 |
| AlohaCare | Medicare | $331 |
| Ohana Health Plan | Medicare | $331 |
| Devoted Health | Medicare | $364 |
| Hawaii Western Management Group | Commercial | $393 |
| Kaiser Permanente | Medicaid | $416 |
| Hawaii Medical Service Association | Commercial | $446 |
| Hawaii Medical Service Association | Non-ABD | $490 |
| Health Management Network | Commercial | $681 |
| University Health Alliance | Commercial | $728 |
| Humana | Medicare | $5,103 |
| MDX Hawaii | PPO | $9,899 |
Inpatient
$2,287cash price (self-pay)
$10,205list price
$2,990–$9,899range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Management Network | Commercial | $8,674 |
| Kaiser Permanente | Commercial | $9,185 |
| MDX Hawaii | PPO | $9,899 |
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