Supplies, drugs & other prices at Samuel Mahelona Memorial Hospital
Kapaa, HI · every code in this section with a posted price and a Medicare benchmark.
18 codes. Prices are the hospital's own posted facility charges.
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| Procedure | Cash price | Gross charge | × Medicare |
|---|---|---|---|
| 2019-ncov diagnostic p (U0001) | $159.25 | $245 | 4.4× |
| Admin hepatitis b vaccine (G0010) | $15.60 | $24 | 0.3× |
| Admin influenza virus vac (G0008) | $101.72 | $156.50 | 1.8× |
| Admin pneumococcal vaccine (G0009) | $73.45 | $113 | 1.3× |
| Alcohol/subs interv 15-30mn (G0396) | $91.65 | $141 | 2.1× |
| Alcohol/subs interv >30 min (G0397) | $146.25 | $225 | 0.7× |
| Catheterize for urine spec (P9612) | $29.90 | $46 | 3.2× |
| Depression screen annual (G0444) | $20.15 | $31 | 0.5× |
| Devlopment test interpt&rep (G0451) | $94.90 | $146 | 0.8× |
| Direct refer hospital observ (G0379) | $576.55 | $887 | 0.8× |
| Drug test def 1-7 classes (G0480) | $153.40 | $236 | 1.3× |
| Drug test def 8-14 classes (G0481) | $726.70 | $1,118 | 4.6× |
| Elec stim other than wound (G0283) | $44.85 | $69 | 3.5× |
| Hospital outpt clinic visit (G0463) | $190.45 | $293 | 1.2× |
| Prolonged iv inf, req pump (C8957) | $382.20 | $588 | 1.5× |
| Psa screening (G0103) | $86.12 | $132.50 | 4.5× |
| Tte w or w/o fol w/cont, com (C8921) | $1,682.85 | $2,589 | 1.8× |
| Wet mounts/ w preparations (Q0111) | $44.85 | $69 | 2.4× |