Home › Hospitals › Samuel Mahelona Memorial Hospital Posts prices for 33 of the 66 common shoppable procedures we track. Price file retrieved 2026-08-28.
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Procedure Cash price Gross charge × Medicare
Epidural injection, lumbar/sacral (with imaging) (62322) $793
$1,220
0.8×
CT head/brain without contrast (70450) $1,040.65
$1,601
8.4×
X-ray lower spine, 4+ views (72110) $492.70
$758
4.0×
CT pelvis with contrast (72193) $1,010.75
$1,555
4.9×
MRI lower-extremity joint without contrast (73721) $1,131.65
$1,741
4.0×
CT abdomen and pelvis with contrast (74177) $6,633.25
$10,205
16.1×
Ultrasound, abdomen complete (76700) $492.70
$758
4.0×
Ultrasound, pregnant uterus (≥14 weeks) (76805) $494.65
$761
4.0×
Ultrasound, transvaginal (76830) $492.70
$758
4.0×
Mammography, one breast (diagnostic) (77065) $374.40
$576
4.3×
Mammography, both breasts (diagnostic) (77066) $521.30
$802
4.7×
Mammography, screening (bilateral) (77067) $301.60
$464
3.3×
Basic metabolic panel (80048) $76.05
$117
9.0×
Comprehensive metabolic panel (80053) $91.65
$141
8.7×
Lipid panel (80061) $100.10
$154
7.5×
Renal function panel (80069) $73.45
$113
8.5×
Hepatic function panel (80076) $78
$120
9.5×
Urinalysis, non-automated, with microscopy (81000) $26.65
$41
6.6×
Urinalysis, non-automated, without microscopy (81002) $22.75
$35
6.5×
PSA, total (84153) $90.35
$139
4.9×
Thyroid stimulating hormone (TSH) (84443) $110.50
$170
6.6×
CBC with automated differential (85025) $74.10
$114
9.5×
CBC, automated (85027) $62.40
$96
9.6×
Prothrombin time (PT) (85610) $43.55
$67
10.2×
Partial thromboplastin time (PTT) (85730) $53.95
$83
9.0×
Psychotherapy, 30 minutes (90832) $160.55
$247
0.8×
Psychotherapy, 45 minutes (90834) $160.55
$247
0.8×
Psychotherapy, 60 minutes (90837) $149.50
$230
0.7×
Family psychotherapy, without patient (50 min) (90846) $723.45
$1,113
3.5×
Family psychotherapy, with patient (50 min) (90847) $160.55
$247
0.8×
Group psychotherapy (90853) $91.65
$141
0.8×
Physical therapy, therapeutic exercise (per 15 min) (97110) $129.35
$199
4.5×
Office visit, new patient (high complexity, ~60 min) (99205) $224.90
$346
1.4×
As a Critical Access Hospital, Medicare pays this facility about 101% of its own costs. The × Medicare column compares the cash price against that cost-based benchmark, not a standard rate.
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