Visits & medical services prices at Samuel Mahelona Memorial Hospital
Kapaa, HI · every code in this section with a posted price and a Medicare benchmark.
157 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 1St psychiatric collab care mgmt 1st 70 mins (99492) | $157.30 | $242 | 1.3× |
| Actinotherapy Ultraviolet Light (96900) | $90.35 | $139 | 2.0× |
| Admn Sarscov2 Vacc 1 Dose (90480) | $55.25 | $85 | 1.2× |
| Aep Hearing Status Deter Broadband Stimuli I&R (92651) | $498.55 | $767 | 2.0× |
| Airway Inhalation Treatment (94640) range across 7 matching MRF lines |
$278.20–$339.30 | $428–$522 | varies |
| Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) | $67.60 | $104 | 4.7× |
| Application Modality 1/> Areas Infrared (97026) | $29.25 | $45 | 4.4× |
| Assessment of aphasia per hr (96105) | $384.15 | $591 | 4.0× |
| Behavral qualit analys voice (92524) | $427.05 | $657 | 3.9× |
| Brncdilat rspse spmtry pre&post-brncdilat admn (94060) | $431.60 | $664 | 1.0× |
| Canalith repositioning proc (95992) | $130 | $200 | 3.2× |
| Car seat/bed test 60 min (94780) range across 2 matching MRF lines |
$126.75–$140.40 | $195–$216 | varies |
| Cardiac Stress Tst,Tracing Only (93017) range across 3 matching MRF lines |
$863.85–$1,261 | $1,329–$1,940 | varies |
| Cardiopulmonary exercise testing (94621) | $122.20 | $188 | 0.3× |
| Cardiopulmonary resuscitation (92950) | $811.85 | $1,249 | 3.2× |
| Cardioversion (92960) range across 2 matching MRF lines |
$1,724.45–$2,057.90 | $2,653–$3,166 | varies |
| Care mgmt services behavioral hlth cond 20 mins (99484) | $44.20 | $68 | 1.0× |
| Cbt 1st hour (94644) | $243.75 | $375 | 1.6× |
| Chest Wall Manipulation (94668) | $165.75 | $255 | 1.1× |
| Color/duplex Doppler, complete (93975) range across 3 matching MRF lines |
$910.65–$1,812.20 | $1,401–$2,788 | varies |
| Color/duplex Doppler, limited (93976) range across 5 matching MRF lines |
$607.75–$1,231.75 | $935–$1,895 | varies |
| Community/Work Reintegration Trainj Ea 15 Min (97537) | $163.15 | $251 | 5.1× |
| Continuous Pulse Ox (94762) | $390 | $600 | 2.6× |
| Cpap Ventilation Cpap Initiation&Mgmt (94660) | $1,082.90 | $1,666 | 4.2× |
| Cpt initial (94667) | $227.50 | $350 | 1.4× |
| Critical care first hour (99291) | $4,966 | $7,640 | 5.1× |
| Debridement Open Wound 20 Sq Cm< (97597) range across 7 matching MRF lines |
$360.75–$450.45 | $555–$693 | varies |
| Dup-scan aorta ivc iliac vascl/bpgs complete (93978) | $1,457.30 | $2,242 | 5.2× |
| Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) | $1,018.55 | $1,567 | 8.2× |
| Dup-scan lxtr art/artl bpgs compl bi study (93925) | $679.25 | $1,045 | 2.4× |
| Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) | $481 | $740 | 3.9× |
| Dup-Scan Xtr Veins Complete Bilateral Study (93970) | $992.55 | $1,527 | 3.5× |
| Dup-scan xtr veins unilateral/limited study (93971) range across 16 matching MRF lines |
$494.65–$559.65 | $761–$861 | varies |
| Duplex Scan Hemodialysis Access (93990) | $492.70 | $758 | 4.0× |
| Duplex up extrem art bilat (93930) | $900.90 | $1,386 | 3.2× |
| Duplex up extrem art unilat/ltd (93931) | $460.20 | $708 | 3.7× |
| Echo Congenital Complete (93303) | $1,816.75 | $2,795 | 2.8× |
| Echo Heart Xthoracic,Limited (93308) range across 4 matching MRF lines |
$808.60–$1,002.30 | $1,244–$1,542 | varies |
| Echo transesophageal (93312) | $1,976 | $3,040 | 3.1× |
| Eeg 41-60 Minutes (95812) | $1,023.75 | $1,575 | 4.0× |
| EEG awake and asleep (95819) | $1,023.75 | $1,575 | 4.0× |
| EEG awake drowsy (95816) range across 3 matching MRF lines |
$864.50–$999.05 | $1,330–$1,537 | varies |
| EEG cerebral death evaluation (95824) | $1,398.15 | $2,151 | 3.2× |
| EEG extended monitoring 61-119 minutes (95813) | $1,023.75 | $1,575 | 4.0× |
| Eeg Sleep Only (95822) | $1,023.75 | $1,575 | 4.0× |
| Eeg W/O Vid 2-12 Hr Unmntr (95705) | $1,287.65 | $1,981 | 5.0× |
| EEG w/o vid 2-12hr cont mntr (95707) | $874.90 | $1,346 | 3.4× |
| EEG w/o vid ea 12-26hr intmt (95709) | $2,209.35 | $3,399 | 5.0× |
| Eeg W/O Vid Tech Ea Incr 12-26 Hr Cont R-T Mntr (95710) | $1,677.65 | $2,581 | 3.8× |
| EEG w/o video by tech 2-12 hr intermittent mntr (95706) | $1,287.65 | $1,981 | 5.0× |
| EEG wo vid ea 12-26hr unmntr (95708) | $2,209.35 | $3,399 | 5.0× |
| Electrical Stimulation Ea 15 Min (97032) | $72.80 | $112 | 5.0× |
| Electrocardiogram Tracing (93005) range across 4 matching MRF lines |
$240.50–$260 | $370–$400 | varies |
| Emergency Dept Visit Level 2 (99282) | $815.75 | $1,255 | 4.5× |
| Emergency Dept Visit Level 3 (99283) | $1,090.70 | $1,678 | 3.4× |
| Emergency Dept Visit Level 4 (99284) | $1,956.50 | $3,010 | 4.0× |
| Er level 1 (99281) | $473.20 | $728 | 4.8× |
| Er level v (99285) | $3,019.90 | $4,646 | 4.3× |
| Evaluate pt use of inhaler (94664) | $170.30 | $262 | 0.7× |
| Evaluate Speech Production (92522) | $432.25 | $665 | 3.9× |
| Evaluate Swallowing Function (92610) range across 5 matching MRF lines |
$328.25–$338.65 | $505–$521 | varies |
| Evaluation of speech fluency (92521) | $505.70 | $778 | 3.8× |
| Evoked Auditory Test,Limited (92587) range across 3 matching MRF lines |
$412.10–$498.55 | $634–$767 | varies |
| Exercise test for bronchospasm (94617) | $441.35 | $679 | 2.8× |
| Extracranial Bilat Study (93880) | $852.15 | $1,311 | 3.0× |
| Extracranial Uni/Ltd Study (93882) | $520 | $800 | 4.2× |
| Group Therapeutic Procedures (97150) | $85.80 | $132 | 4.8× |
| Hemodialysis Procedure W/ Phys/Qhp Evaluation (90935) | $1,283.75 | $1,975 | 1.6× |
| Immunization administration (90471) range across 6 matching MRF lines |
$65.65–$137.15 | $101–$211 | varies |
| Insert/Place Heart Catheter (93503) | $5,276.70 | $8,118 | 2.8× |
| Intracranial Complete Study (93886) | $900.90 | $1,386 | 3.2× |
| Iontophoresis 15 min (97033) | $91.65 | $141 | 4.8× |
| Irrig Drug Delivery Device (96523) | $104 | $160 | 1.5× |
| IV infusion hydration each additional hour (96361) range across 4 matching MRF lines |
$234–$238.55 | $360–$367 | varies |
| IV infusion hydration initial 31 min-1 hour (96360) range across 5 matching MRF lines |
$427.05–$431.60 | $657–$664 | varies |
| IV infusion ther proph addl sequential to 1 hr (96367) range across 3 matching MRF lines |
$243.75–$246.35 | $375–$379 | varies |
| IV infusion therapy prophylaxis/dx ea hour (96366) range across 3 matching MRF lines |
$227.50–$235.95 | $350–$363 | varies |
| IV push initial (96374) range across 4 matching MRF lines |
$279.50–$304.85 | $430–$469 | varies |
| Lung Function Test (Mbc/Mvv) (94200) | $224.90 | $346 | 3.2× |
| Motion Fluoroscopy/Swallow (92611) range across 3 matching MRF lines |
$296.40–$377.65 | $456–$581 | varies |
| Multiple Family Group Psychotherapy (90849) | $160.55 | $247 | 0.8× |
| Nasopharyngoscopy (92511) | $710.45 | $1,093 | 3.0× |
| Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) range across 4 matching MRF lines |
$801.45–$1,001.65 | $1,233–$1,541 | varies |
| Neg Pressure Wound Therapy Non Dme >50 Sq Cm (97608) range across 4 matching MRF lines |
$801.45–$1,001.65 | $1,233–$1,541 | varies |
| Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) | $257.40 | $396 | 1.1× |
| Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) | $529.75 | $815 | 1.1× |
| Neuromuscular Reeducation (97112) | $172.90 | $266 | 5.3× |
| Newborn resuscitation (99465) range across 2 matching MRF lines |
$848.25–$892.45 | $1,305–$1,373 | varies |
| Oral Function Therapy (92526) | $346.45 | $533 | 4.1× |
| Orthc/Prostc Mgmt Sbsq Enc (97763) range across 4 matching MRF lines |
$183.95–$229.45 | $283–$353 | varies |
| Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) | $183.30 | $282 | 4.0× |
| Ot Contrast Bath Ea 15 Min (97034) | $65.65 | $101 | 4.7× |
| Ot eval high complexity (97167) | $392.60 | $604 | 3.9× |
| Ot Eval Low Complex (97165) | $335.40 | $516 | 3.3× |
| Ot Eval Moderate Complexity (97166) | $382.20 | $588 | 3.8× |
| Ot manual therapy 15 min (97140) range across 7 matching MRF lines |
$57.85–$150.15 | $89–$231 | varies |
| Ot paraffin bath (97018) range across 7 matching MRF lines |
$27.30–$36.40 | $42–$56 | varies |
| Ot Prosthetic Training, Each 15 Min (97761) | $169 | $260 | 4.2× |
| Ot Re-Eval Est Plan Care (97168) | $293.15 | $451 | 4.3× |
| Ot rom hand (95852) | $42.25 | $65 | 2.0× |
| Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) | $396.50 | $610 | 1.5× |
| Phlebotomy therapeutic (99195) range across 2 matching MRF lines |
$357.50–$365.30 | $550–$562 | varies |
| Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) | $312.65 | $481 | 4.5× |
| Physical Performance Test (97750) range across 4 matching MRF lines |
$148.85–$178.75 | $229–$275 | varies |
| Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx (95115) | $33.15 | $51 | 0.6× |
| Prof svcs allg immntx x w/prv allgic xtrcs njxs (95117) | $49.40 | $76 | 0.9× |
| Psych diag eval w/med srvcs (90792) | $715.65 | $1,101 | 3.4× |
| Psychiatric diagnostic evaluation (90791) | $292.50 | $450 | 1.4× |
| Psytx Crisis Initial 60 Min (90839) range across 2 matching MRF lines |
$146.25–$160.55 | $225–$247 | varies |
| Pt Eval High Complex (97163) | $378.95 | $583 | 3.9× |
| Pt eval low complex 20 min (97161) | $461.50 | $710 | 4.7× |
| Pt Eval Mod Complex (97162) | $378.95 | $583 | 3.9× |
| Pt gait training 15 min (97116) | $154.70 | $238 | 5.3× |
| Pt mechanical traction (97012) | $82.55 | $127 | 5.7× |
| Pt Re-Eval Est Plan Care (97164) | $276.90 | $426 | 4.1× |
| Pulm function test by gas (94727) | $252.85 | $389 | 1.0× |
| Pulmonary Stress Testing (94618) | $527.15 | $811 | 3.4× |
| Refill/Maint Portable Pump (96521) | $561.60 | $864 | 2.2× |
| Respiratory flow volume loop (94375) | $534.30 | $822 | 2.1× |
| Rhythm Ecg 1-3 Leads Tracing Only W/O I&R (93041) range across 2 matching MRF lines |
$113.75–$137.80 | $175–$212 | varies |
| Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) range across 4 matching MRF lines |
$317.20–$319.15 | $488–$491 | varies |
| Rom Meas&Reprt Ea Xtr Ex Hand/Ea Trnk Sctj Spi (95851) | $65 | $100 | 2.5× |
| Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) | $268.45 | $413 | 2.2× |
| Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) | $147.55 | $227 | 3.1× |
| Self Care Mngment Training (97535) | $143 | $220 | 4.4× |
| Sensory Integration Ea 15 Min (97533) | $154.70 | $238 | 2.5× |
| Sleep study unattended (95806) | $837.20 | $1,288 | 3.3× |
| Speech sound lang comprehen (92523) | $371.80 | $572 | 1.6× |
| Spirometry (94010) | $339.30 | $522 | 1.3× |
| Standardized Cognitive Performance Testing (96125) range across 2 matching MRF lines |
$141.70–$176.80 | $218–$272 | varies |
| Stress Tte Only (93350) | $1,394.25 | $2,145 | 2.2× |
| Surfactant Admin Thru Tube (94610) | $278.20 | $428 | 1.1× |
| Temp transcutaneous pacing (92953) range across 2 matching MRF lines |
$969.15–$2,676.05 | $1,491–$4,117 | varies |
| Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) range across 6 matching MRF lines |
$98.80–$100.75 | $152–$155 | varies |
| Ther Ivntj Ea Addl 15 Min (97130) | $96.85 | $149 | 4.6× |
| Ther Px 1/> Areas Each 15 Minutes Massage (97124) | $134.55 | $207 | 4.5× |
| Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) | $163.15 | $251 | 1.6× |
| Ther/Prop/Diag Inj/Inf Proc (96379) | $169 | $260 | 3.1× |
| Ther/Proph/Diag Inj Ia (96373) | $304.85 | $469 | 1.2× |
| Ther/Proph/Diag Inj Sc/Im (96372) range across 5 matching MRF lines |
$133.25–$162.50 | $205–$250 | varies |
| Ther/Proph/Diag Iv Inf Init (96365) range across 5 matching MRF lines |
$198.25–$520 | $305–$800 | varies |
| Therapeutic Activities (97530) range across 7 matching MRF lines |
$159.90–$199.55 | $246–$307 | varies |
| Tobacco Use Cessation Intensive >10 Minutes (99407) | $104 | $160 | 2.3× |
| Tobacco Use Cessation Intermediate 3-10 Minutes (99406) | $104 | $160 | 2.3× |
| Transcranial Doppler Stdy Intracranial Art Lmtd (93888) | $460.20 | $708 | 3.7× |
| Tte w/doppler, complete (93306) | $1,976 | $3,040 | 3.1× |
| Tte W/O Doppler Complete (93307) | $942.50 | $1,450 | 3.3× |
| Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) | $267.15 | $411 | 3.5× |
| Tx Speech Language Voice Commj Auditry 2/>Indiv (92508) | $115.05 | $177 | 4.8× |
| Tx/Pro/Dx Inj New Drug Addon (96375) range across 3 matching MRF lines |
$211.25–$217.75 | $325–$335 | varies |
| Upr/Lxtr Art Stdy 3+ Lvls (93923) | $453.70 | $698 | 1.8× |
| Vasopneumatic device (97016) | $59.80 | $92 | 5.0× |
| Vent Mgmt Inpat Init Day (94002) | $1,814.15 | $2,791 | 2.5× |
| Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) | $1,632.15 | $2,511 | 2.2× |
| Vital capacity, total (94150) | $276.90 | $426 | 1.8× |
| Wheelchair Mgmt Ea 15 Min (97542) | $167.05 | $257 | 5.4× |
| Whirlpool Therapy (97022) | $81.90 | $126 | 5.2× |
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.