Imaging prices at Samuel Mahelona Memorial Hospital
Kapaa, HI · every code in this section with a posted price and a Medicare benchmark.
207 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Abdomen 1 View (74018) | $238.55 | $367 | 2.3× |
| Abdomen 2 views (74019) range across 2 matching MRF lines |
$250.25–$377 | $385–$580 | varies |
| Ankle 2 views (73600) | $270.40 | $416 | 2.6× |
| Arthrogram ankle (73615) | $988 | $1,520 | 2.4× |
| Arthrogram hip (73525) | $988 | $1,520 | 2.4× |
| Arthrogram Wrist (73115) | $1,233.70 | $1,898 | 3.0× |
| Bone age studies (77072) | $228.80 | $352 | 1.9× |
| Bone survey infant (77076) | $377 | $580 | 3.1× |
| Cat Scan Follow-Up Study (76380) | $409.50 | $630 | 4.0× |
| Chest 1 view (71045) | $244.40 | $376 | 2.4× |
| Chest 2 views (71046) | $287.95 | $443 | 2.8× |
| Chest 3 views (71047) | $367.25 | $565 | 3.6× |
| Chest 4 or more views (71048) | $393.90 | $606 | 3.2× |
| Clavicle complete (73000) range across 3 matching MRF lines |
$279.50–$340.60 | $430–$524 | varies |
| Computed Tomography Thorax Lw Dose Lng Ca Scr C- (71271) | $289.90 | $446 | 2.3× |
| Contrast X-Ray Bladder (74430) | $724.10 | $1,114 | 1.8× |
| Contrast X-Ray Of Elbow (73085) | $988 | $1,520 | 2.4× |
| Contrast X-Ray Of Knee Joint (73580) | $1,233.70 | $1,898 | 3.0× |
| CT abdomen and pelvis without and with contrast (74178) range across 2 matching MRF lines |
$2,388.75–$7,482.15 | $3,675–$11,511 | varies |
| CT abdomen and pelvis without contrast (74176) range across 2 matching MRF lines |
$1,774.50–$5,743.40 | $2,730–$8,836 | varies |
| CT abdomen w contrast (74160) | $1,341.60 | $2,064 | 6.5× |
| CT abdomen w wo contrast (74170) | $1,476.80 | $2,272 | 7.1× |
| CT abdomen w/o contrast (74150) range across 2 matching MRF lines |
$1,033.50–$2,898.35 | $1,590–$4,459 | varies |
| CT Angio Abdomen and Pelvis (74174) | $1,780.35 | $2,739 | 4.3× |
| CT Angio Chest (71275) range across 3 matching MRF lines |
$1,515.80–$4,732.65 | $2,332–$7,281 | varies |
| CT Angio Head (70496) | $1,164.15 | $1,791 | 5.6× |
| Ct Angio Lwr Extr W/O&W/Dye (73706) | $1,285.05 | $1,977 | 6.2× |
| CT Angio Neck (70498) | $1,148.55 | $1,767 | 5.5× |
| Ct Angio Upr Extrm W/O&W/Dye (73206) | $1,285.05 | $1,977 | 6.2× |
| CT bone density (77078) | $373.10 | $574 | 3.6× |
| CT cervical spine w/ contrast (72126) | $1,457.95 | $2,243 | 3.5× |
| CT cervical spine w/o contrast (72125) | $955.50 | $1,470 | 7.7× |
| CT cervical spine w/wo cont (72127) | $1,214.85 | $1,869 | 5.9× |
| CT chest w contrast (71260) range across 3 matching MRF lines |
$1,458.60–$3,788.20 | $2,244–$5,828 | varies |
| CT chest w/wo contrast (71270) range across 3 matching MRF lines |
$1,604.20–$4,169.10 | $2,468–$6,414 | varies |
| CT head/brain with contrast (70460) | $1,010.75 | $1,555 | 4.9× |
| CT head/brain without and with contrast (70470) | $1,376.70 | $2,118 | 6.6× |
| CT heart no contrast quant eval coronry calcium (75571) | $287.95 | $443 | 2.8× |
| CT iac w contrast (70481) | $1,348.10 | $2,074 | 6.5× |
| CT l-spine w&w/o contrast (72133) | $1,002.30 | $1,542 | 4.8× |
| CT lower ext w/o (73700) | $1,073.15 | $1,651 | 8.7× |
| CT lower extremity w/contrast material (73701) | $1,214.85 | $1,869 | 5.9× |
| CT lumbar spine w contrast (72132) | $1,322.10 | $2,034 | 3.2× |
| CT lumbar spine w/o contrast (72131) | $716.95 | $1,103 | 5.8× |
| CT maxillofacial w contrast (70487) range across 2 matching MRF lines |
$1,123.20–$3,576.30 | $1,728–$5,502 | varies |
| CT maxillofacial wo contrast (70486) range across 7 matching MRF lines |
$3,027.05–$3,033.55 | $4,657–$4,667 | varies |
| CT neck tissue combo (70492) range across 5 matching MRF lines |
$1,604.20–$3,768.70 | $2,468–$5,798 | varies |
| Ct Orbit/Ear/Fossa W/O&W/Dye (70482) | $1,336.40 | $2,056 | 6.4× |
| CT orbits w/o contrast (70480) | $993.20 | $1,528 | 8.0× |
| CT pelvis w&w/o contrast (72194) | $1,067.95 | $1,643 | 5.2× |
| CT pelvis w/o contrast (72192) | $728 | $1,120 | 5.9× |
| CT scan of leg combo (73702) | $1,445.60 | $2,224 | 7.0× |
| CT scans face/jaw combo (70488) range across 2 matching MRF lines |
$1,214.85–$3,760.90 | $1,869–$5,786 | varies |
| CT soft tissue neck w contrast (70491) range across 5 matching MRF lines |
$1,406.60–$3,515.20 | $2,164–$5,408 | varies |
| CT soft tissue neck w/o contrast (70490) | $993.20 | $1,528 | 8.0× |
| CT thoracic spine w contrast (72129) | $1,123.20 | $1,728 | 5.4× |
| CT thoracic spine w/o contrast (72128) | $955.50 | $1,470 | 7.7× |
| CT thoracic spine w/wo cont (72130) | $1,336.40 | $2,056 | 6.4× |
| CT thorax w/o contrast (71250) range across 4 matching MRF lines |
$1,046.50–$3,085.55 | $1,610–$4,747 | varies |
| CT upper ext wo (73200) | $1,073.15 | $1,651 | 8.7× |
| CT upper extremity w/o & w/contrast material (73202) | $1,445.60 | $2,224 | 7.0× |
| CT upper extremity with contrast (73201) range across 2 matching MRF lines |
$1,342.25–$1,469.65 | $2,065–$2,261 | varies |
| Cta Abdomen (74175) range across 2 matching MRF lines |
$1,555.45–$4,129.45 | $2,393–$6,353 | varies |
| CTA pelvis (72191) | $1,257.75 | $1,935 | 6.1× |
| Doppler Fetal Mid Cerebral Artery (76821) | $376.35 | $579 | 3.0× |
| Echo exam uterus (76831) | $629.20 | $968 | 2.2× |
| Esophagram (74220) | $295.10 | $454 | 1.4× |
| Fetal Biophysical Profile W/O Non-Stress Testing (76819) range across 2 matching MRF lines |
$94.25–$440.70 | $145–$678 | varies |
| Fluoroscopy up to 1 hr (76000) | $516.10 | $794 | 1.8× |
| Foot 2 views (73620) | $286 | $440 | 2.8× |
| Forearm 2 views (73090) | $286 | $440 | 2.8× |
| Hand 2 views (73120) | $286 | $440 | 2.3× |
| Hysterosalpingogram (74740) | $694.20 | $1,068 | 2.5× |
| Infant hip ultrasound with hip movement (dynamic) (76885) | $492.70 | $758 | 4.8× |
| Joint Survey Single View (77077) | $272.35 | $419 | 2.2× |
| Knee 3 Views (73562) | $341.25 | $525 | 3.3× |
| Mammary ductogram or galactogram multiple (77054) | $481 | $740 | 1.7× |
| Mammary ductogram or galactogram single (77053) | $481 | $740 | 1.7× |
| MRI any jt lower extrem w/contrast material (73722) | $2,391.35 | $3,679 | 2.6× |
| MRI any jt lower extrem w/o & w/contrast matrl (73723) | $1,907.10 | $2,934 | 4.6× |
| MRI any jt upper extremity w/contrast matrl (73222) | $2,391.35 | $3,679 | 2.6× |
| MRI lower extrem oth/thn jt w/contrast matrl (73719) | $1,602.25 | $2,465 | 3.9× |
| MRI lower extrem oth/thn jt w/o & w/contr matr (73720) | $1,640.60 | $2,524 | 4.0× |
| MRI lower extrem oth/thn jt w/o contr matrl (73718) range across 4 matching MRF lines |
$1,509.30–$1,577.55 | $2,322–$2,427 | varies |
| MRI upper extremity oth than jt w/contr matrl (73219) | $1,602.25 | $2,465 | 3.9× |
| MRI upper extremity oth than jt w/o contr matrl (73218) | $1,509.30 | $2,322 | 5.4× |
| Mri Uppr Extremity W/O&W/Dye (73220) | $1,640.60 | $2,524 | 4.0× |
| MRI, joint upper extrem (73221) | $1,509.30 | $2,322 | 5.4× |
| MRI, joint upper extrem combo (73223) | $1,907.10 | $2,934 | 4.6× |
| Myelogram cervical (72240) | $1,030.25 | $1,585 | 1.1× |
| Myelogram Lumbar (72265) | $1,030.25 | $1,585 | 1.1× |
| Myelography thoracic (72255) | $1,030.25 | $1,585 | 1.1× |
| Myelograpy 2/more regions rs&i (72270) | $1,030.25 | $1,585 | 1.1× |
| Neck soft tissue (70360) | $235.95 | $363 | 2.3× |
| Ophthalmic ultrasound dx b-scan w/wo a-scan (76512) range across 2 matching MRF lines |
$290.55–$297.70 | $447–$458 | varies |
| Pelvis 1 or 2 views (72170) | $250.90 | $386 | 2.0× |
| Radex Abd Compl Aqt Abd W/S/E/D Views 1 View Ch (74022) | $460.20 | $708 | 3.7× |
| Radex abscess/fistula/sinus tract rs&i (76080) | $707.85 | $1,089 | 1.1× |
| Radex Ankle Complete Minimum 3 Views (73610) | $312.65 | $481 | 3.0× |
| Radex Calcaneus Minimum 2 Views (73650) | $199.55 | $307 | 1.9× |
| Radex elbow complete minimum 3 views (73080) | $341.25 | $525 | 3.3× |
| Radex Facial Bones Complete Minimum 3 Views (70150) | $448.50 | $690 | 3.6× |
| Radex fingr minimum 2 views (73140) | $211.25 | $325 | 2.1× |
| Radex foot complete minimum 3 views (73630) | $286 | $440 | 2.8× |
| Radex Hand Minimum 3 Views (73130) | $341.25 | $525 | 3.3× |
| Radex lower extremity infant minimum 2 views (73592) | $247.65 | $381 | 2.4× |
| Radex Nasal Bones Complete Minimum 3 Views (70160) | $271.05 | $417 | 2.6× |
| Radex Ribs Unilateral 2 Views (71100) | $280.15 | $431 | 2.7× |
| Radex shoulder complete minimum 2 views (73030) | $341.25 | $525 | 3.3× |
| Radex Sinuses Paransl < 3 Views (70210) | $340.60 | $524 | 3.3× |
| Radex Spine 1 View Specify Level (72020) | $339.95 | $523 | 3.3× |
| Radex Sternum Minimum 2 Views (71120) | $339.95 | $523 | 3.3× |
| Radex Temporomandble Jt Opn & Clsd Mouth Bilat (70330) | $299.65 | $461 | 2.9× |
| Radex Toe Minimum 2 Views (73660) | $182 | $280 | 1.8× |
| Radex upper extremity infant minimum 2 views (73092) | $282.75 | $435 | 2.3× |
| Radex Wrist Complete Minimum 3 Views (73110) | $341.25 | $525 | 3.3× |
| Radex X-Ray Exam Entire Spi 6/> Vw - Xr Entire Spine 6+ Vw (72084) | $502.45 | $773 | 4.1× |
| Radiolog exam mandible compl minimum 4 views (70110) | $412.75 | $635 | 3.3× |
| Radiologic Exam Abdomen 3+ Views - Xr Abdomen 3+ Views (74021) | $280.15 | $431 | 2.3× |
| Radiologic exam colon double contrast study (74280) | $725.40 | $1,116 | 3.5× |
| Radiologic exam colon single contrast study (74270) | $689.65 | $1,061 | 3.3× |
| Radiologic exam knee complete 4/more views (73564) range across 3 matching MRF lines |
$558.35–$561.60 | $859–$864 | varies |
| Radiologic exam pelvis compl minimum 3 views (72190) | $356.20 | $548 | 2.9× |
| Radiologic Exam Small Int Single Contrast Study (74250) | $601.25 | $925 | 2.9× |
| Radiologic exam swallow function contrast study (74230) | $460.85 | $709 | 2.2× |
| Radiologic exam upr gi trc double contrast study (74246) | $689.65 | $1,061 | 3.3× |
| Radiologic examination femur 1 view (73551) | $258.70 | $398 | 2.5× |
| Radiologic examination femur minimum 2 views (73552) | $284.70 | $438 | 2.8× |
| Radiologic examination knee 1/2 views (73560) | $367.25 | $565 | 3.6× |
| Radiologic Examination Osseous Survey Limited (77074) | $348.40 | $536 | 2.8× |
| Radiologic examination tibia & fibula 2 views (73590) | $280.15 | $431 | 2.7× |
| Ribs bilateral 3 views (71110) | $375.70 | $578 | 3.0× |
| Scapula (73010) | $340.60 | $524 | 2.8× |
| Screening Digital Breast Tomosynthesis Bi (77063) range across 11 matching MRF lines |
$48.75–$60.45 | $75–$93 | varies |
| Sella turcica (70240) | $207.35 | $319 | 2.0× |
| Shoulder 1 view (73020) | $258.05 | $397 | 2.5× |
| Shoulder Arthrography (73040) | $1,233.70 | $1,898 | 3.0× |
| Sialogram (70390) | $481 | $740 | 1.7× |
| Skull less than 4 views (70250) | $340.60 | $524 | 2.8× |
| Sternoclavicular joints (71130) | $339.95 | $523 | 3.3× |
| Thoracic spine 2 views (72070) | $334.75 | $515 | 2.7× |
| Thoracic spine 3 views (72072) | $359.45 | $553 | 2.9× |
| Thoracolumbar 2 views (72080) | $375.70 | $578 | 3.7× |
| Ultrasound Breast Limited (76642) | $568.10 | $874 | 5.5× |
| Ultrasound Exam Aaa Screen (76706) | $183.95 | $283 | 1.5× |
| Ultrasound, abdomen limited (76705) range across 6 matching MRF lines |
$460.20–$525.20 | $708–$808 | varies |
| Umbilical-artery Doppler (OB) (76820) | $440.70 | $678 | 3.6× |
| Upper gi w/o kub (74240) | $572 | $880 | 2.8× |
| Urethrocystogram voiding (74455) | $724.10 | $1,114 | 2.6× |
| Urethrocystography retrograde (74450) | $802.10 | $1,234 | 2.8× |
| Us breast unilateral complete (76641) | $605.80 | $932 | 4.9× |
| Us chest (76604) range across 6 matching MRF lines |
$443.30–$841.75 | $682–$1,295 | varies |
| Us complete joint (76881) range across 11 matching MRF lines |
$492.70–$557.70 | $758–$858 | varies |
| Us exam, pelvic, limited (76857) range across 7 matching MRF lines |
$269.75–$793.65 | $415–$1,221 | varies |
| Us head (76506) | $352.95 | $543 | 2.9× |
| Us kidney transplant (76776) | $1,187.55 | $1,827 | 9.6× |
| Us lmtd joint/oth nonvasc xtr strux r-t w/img (76882) range across 18 matching MRF lines |
$492.70–$697.45 | $758–$1,073 | varies |
| Us ob detailed single fetus (76811) range across 2 matching MRF lines |
$722.15–$828.75 | $1,111–$1,275 | varies |
| Us ob limited 1 or more fetuses (76815) range across 5 matching MRF lines |
$149.50–$525.20 | $230–$808 | varies |
| Us ob transvaginal (76817) range across 7 matching MRF lines |
$492.70–$557.70 | $758–$858 | varies |
| Us pelvic non ob complete (76856) range across 2 matching MRF lines |
$495.95–$527.15 | $763–$811 | varies |
| Us pg uter img f&mat 14 wk tabdl 1/1st gestation (76801) | $492.70 | $758 | 4.0× |
| Us preg uterus real time f/u trnsabdl per fetus (76816) range across 3 matching MRF lines |
$372.45–$461.50 | $573–$710 | varies |
| Us retroperitoneal complete (76770) range across 3 matching MRF lines |
$492.70–$1,277.25 | $758–$1,965 | varies |
| Us retroperitoneal limited (76775) range across 4 matching MRF lines |
$460.20–$975 | $708–$1,500 | varies |
| Us scrotum and contents (76870) range across 4 matching MRF lines |
$492.70–$559.65 | $758–$861 | varies |
| Us spinal canal and contents (76800) | $819 | $1,260 | 6.6× |
| Us thyroid (76536) range across 3 matching MRF lines |
$397.15–$525.20 | $611–$808 | varies |
| Venography extremity bilateral rs&i (75822) | $2,042.95 | $3,143 | 1.1× |
| Venography extremity unilateral rs&i (75820) | $2,042.95 | $3,143 | 1.1× |
| Wrist 2 views (73100) | $377 | $580 | 3.7× |
| X-Ray Ac Jts - Xr Acromioclavicular Joints Bilateral (73050) | $339.95 | $523 | 3.3× |
| X-Ray Bend Only L-S Spine (72120) | $460.20 | $708 | 3.7× |
| X-Ray Elbow 2 Vw - Xr Elbow 1-2 Views Right (73070) | $212.55 | $327 | 2.1× |
| X-Ray Exam Breast Specimen (76098) | $2,635.10 | $4,054 | 4.1× |
| X-Ray Exam Entire Spi 1 Vw (72081) | $299.65 | $461 | 2.9× |
| X-Ray Exam Entire Spi 2/3 Vw (72082) | $354.25 | $545 | 2.9× |
| X-Ray Exam Entire Spi 4/5 Vw (72083) | $384.80 | $592 | 3.1× |
| X-Ray Exam Hip Uni 1 View (73501) | $263.90 | $406 | 2.6× |
| X-Ray Exam Hip Uni 2-3 Views (73502) | $263.90 | $406 | 2.6× |
| X-Ray Exam Hip Uni 4/> Views (73503) | $395.85 | $609 | 3.2× |
| X-Ray Exam Hips Bi 2 Views (73521) | $434.85 | $669 | 3.5× |
| X-Ray Exam Hips Bi 3-4 Views (73522) | $434.85 | $669 | 3.5× |
| X-Ray Exam Hips Bi 5/> Views (73523) | $502.45 | $773 | 4.1× |
| X-Ray Exam L-S Spine Bending (72114) | $460.20 | $708 | 3.7× |
| X-Ray Exam Neck Spine 2-3 Vw (72040) | $316.55 | $487 | 3.1× |
| X-Ray Exam Neck Spine 6/>Vws (72052) | $483.60 | $744 | 3.9× |
| X-Ray Exam Unilat Ribs/Chest (71101) | $341.25 | $525 | 2.8× |
| X-ray eye for foreign body (70030) | $256.10 | $394 | 2.5× |
| X-ray humerus (73060) | $286 | $440 | 2.8× |
| X-Ray Jaw <4 Vw - Xr Mandible < 4 Views (70100) | $338.65 | $521 | 3.3× |
| X-Ray Lumbar Spine 2/3 Vw - Xr Lumbar Spine 2-3 Views (72100) | $375.70 | $578 | 3.0× |
| X-ray nose-rectum child f.b. (76010) | $299.65 | $461 | 2.9× |
| X-Ray Ribs, Chest 4+ Vw - Xr Ribs 3 Vws Bil W/ Chest Posteroanterior (71111) | $433.55 | $667 | 3.5× |
| X-Ray Sacroiliac Jts 3+ Vw - Xr Sacroiliac Joints 3+ Views (72202) | $360.10 | $554 | 2.9× |
| X-Ray Sacroiliac Jts <3 Vw - Xr Sacroiliac Joints 1-2 Views (72200) | $272.35 | $419 | 2.2× |
| X-Ray Sacrum/Coccyx 2+ Vw - Xr Sacrum Coccyx 2+ Views (72220) | $267.15 | $411 | 2.6× |
| X-Ray Sinuses 3+ Vw - Xr Paranasal Sinuses 3+ Views (70220) | $348.40 | $536 | 3.4× |
| X-Ray Skull 4+ Vw - Xr Skull Complete 4+ Views (70260) | $406.25 | $625 | 3.3× |
| X-ray thoracic spine 4 vw (72074) | $356.20 | $548 | 2.9× |
| X-Ray Tmj Unilat (70328) | $272.35 | $419 | 2.6× |
| X-Rays Bone Length Studies (77073) | $460.20 | $708 | 3.7× |
| X-Rays Bone Survey Complete (77075) | $484.90 | $746 | 3.9× |
| Xr c-spine 4 or 5 views (72050) | $384.15 | $591 | 3.1× |
| Xr facial bones less than 3 views (70140) | $375.70 | $578 | 3.7× |
| XR Mastoids < 3 Views Bilateral (70120) | $207.35 | $319 | 1.7× |
| Xr orbits complete 4 views (70200) | $317.20 | $488 | 2.6× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.