Samuel Mahelona Memorial Hospital

4800 Kawaihau Road, Kapaa, HI 96746 · (808) 822-4961

Critical Access HospitalsGovernment - StateKapaa, HI metro

Price file

Prices published

File dated 2026-06-15

3,255 price rows for 61 procedures

Published prices

cash · negotiated range · list

Basic metabolic panel (blood test)

CPT 80048 · lowest of 2 lines · metro median $76

$76

cash

$8 to $113

22 negotiated rates

$117

list

CT scan of the abdomen and pelvis, with contrast

CPT 74177 · lowest of 8 lines · metro median $337

$337

cash

$181 to $9,899

92 negotiated rates

$519

list

CT scan of the head, no contrast

CPT 70450 · lowest of 2 lines · metro median $1,041

$1,041

cash

$107 to $1,553

22 negotiated rates

$1,601

list

CT scan of the pelvis, with contrast

CPT 72193 · lowest of 2 lines · metro median $1,011

$1,011

cash

$179 to $1,508

22 negotiated rates

$1,555

list

Cataract surgery with lens implant

CPT 66984 · metro median $2,088

$2,088

cash

$181 to $2,730

40 negotiated rates

$3,212

list

Cesarean delivery with prenatal and postpartum care

CPT 59510 · metro median $4,449

$4,449

cash

$181 to $5,818

53 negotiated rates

$6,845

list

Cesarean section hospital stay, no complications

MS-DRG 788

—

cash

$16,923 to $16,923

1 negotiated rates

—

list

Chlamydia test (DNA)

CPT 87491 · lowest of 4 lines · metro median $237

$237

cash

$35 to $354

44 negotiated rates

$365

list

Colonoscopy (diagnostic)

CPT 45378 · metro median $797

$797

cash

$125 to $1,042

59 negotiated rates

$1,226

list

Colonoscopy with biopsy

CPT 45380 · metro median $1,082

$1,082

cash

$178 to $1,415

59 negotiated rates

$1,665

list

Colonoscopy with polyp removal

CPT 45385 · metro median $1,069

$1,069

cash

$181 to $1,415

59 negotiated rates

$1,644

list

Complete blood count (CBC) with differential

CPT 85025 · lowest of 2 lines · metro median $74

$74

cash

$8 to $111

22 negotiated rates

$114

list

Comprehensive metabolic panel (blood test)

CPT 80053 · lowest of 2 lines · metro median $92

$92

cash

$11 to $137

22 negotiated rates

$141

list

Diagnostic mammogram (both breasts)

CPT 77066 · lowest of 12 lines · metro median $90

$90

cash

$78 to $992

157 negotiated rates

$138

list

Electrocardiogram (ECG) with interpretation

CPT 93000 · lowest of 2 lines · metro median $19

$19

cash

$15 to $434

80 negotiated rates

$29

list

Established patient office visit (about 40 minutes)

CPT 99215 · lowest of 6 lines · metro median $185

$185

cash

$84 to $690

108 negotiated rates

$284

list

Family psychotherapy with the patient

CPT 90847 · lowest of 3 lines · metro median $161

$161

cash

$83 to $240

35 negotiated rates

$247

list

Family psychotherapy without the patient

CPT 90846 · lowest of 3 lines · metro median $433

$433

cash

$72 to $1,080

35 negotiated rates

$666

list

Gallbladder removal (laparoscopic)

CPT 47562 · metro median $1,709

$1,709

cash

$181 to $7,152

53 negotiated rates

$2,629

list

Gonorrhea test (DNA)

CPT 87591 · lowest of 4 lines · metro median $109

$109

cash

$35 to $475

44 negotiated rates

$167

list

Group psychotherapy

CPT 90853 · lowest of 3 lines · metro median $92

$92

cash

$24 to $137

35 negotiated rates

$141

list

Hip or knee replacement, no major complications

MS-DRG 470

—

cash

$10,400 to $27,802

2 negotiated rates

—

list

Hospital stay for digestive disorders, no complications

MS-DRG 392

—

cash

$14,553 to $14,553

1 negotiated rates

—

list

Hysterectomy for non-cancer reasons, no complications

MS-DRG 743

—

cash

$20,028 to $20,028

1 negotiated rates

—

list

Inguinal hernia repair (age 5 and up)

CPT 49505 · metro median $3,239

$3,239

cash

$181 to $4,236

53 negotiated rates

$4,983

list

Knee arthroscopy with meniscus repair

CPT 29881 · metro median $2,960

$2,960

cash

$181 to $3,871

40 negotiated rates

$4,554

list

Laser treatment after cataract surgery (YAG)

CPT 66821 · metro median $601

$601

cash

$181 to $786

40 negotiated rates

$925

list

Lipid panel (cholesterol test)

CPT 80061 · lowest of 2 lines · metro median $100

$100

cash

$13 to $149

22 negotiated rates

$154

list

Liver function panel

CPT 80076 · lowest of 2 lines · metro median $78

$78

cash

$8 to $116

22 negotiated rates

$120

list

Neck (cervical) spinal fusion, no complications

MS-DRG 473

—

cash

$46,006 to $46,006

1 negotiated rates

—

list

Nerve block injection, lower back, with imaging guidance

CPT 64483 · metro median $800

$800

cash

$102 to $1,046

42 negotiated rates

$1,231

list

New patient office visit (about 30 minutes)

CPT 99203 · metro median $76

$76

cash

$71 to $434

55 negotiated rates

$117

list

New patient office visit (about 45 minutes)

CPT 99204 · metro median $375

$375

cash

$113 to $490

40 negotiated rates

$577

list

New patient office visit (about 60 minutes)

CPT 99205 · lowest of 4 lines · metro median $225

$225

cash

$122 to $628

74 negotiated rates

$346

list

PSA test (prostate)

CPT 84153 · lowest of 2 lines · metro median $90

$90

cash

$18 to $135

22 negotiated rates

$139

list

Partial thromboplastin time (blood clotting test)

CPT 85730 · lowest of 2 lines · metro median $54

$54

cash

$6 to $81

22 negotiated rates

$83

list

Pregnancy ultrasound (after first trimester)

CPT 76805 · lowest of 2 lines · metro median $495

$495

cash

$61 to $738

22 negotiated rates

$761

list

Preventive visit, new patient age 18 to 39

CPT 99385 · metro median $198

$198

cash

$65 to $434

36 negotiated rates

$305

list

Preventive visit, new patient age 40 to 64

CPT 99386 · metro median $198

$198

cash

$65 to $434

36 negotiated rates

$305

list

Prostate biopsy

CPT 55700 · metro median $449

$449

cash

$119 to $587

38 negotiated rates

$691

list

Prostate removal (laparoscopic)

CPT 55866 · metro median $9,616

$9,616

cash

$181 to $12,575

40 negotiated rates

$14,794

list

Prothrombin time (blood clotting test)

CPT 85610 · lowest of 4 lines · metro median $44

$44

cash

$4 to $65

44 negotiated rates

$67

list

Psychotherapy, 30 minutes

CPT 90832 · lowest of 3 lines · metro median $78

$78

cash

$47 to $240

35 negotiated rates

$120

list

Psychotherapy, 45 minutes

CPT 90834 · lowest of 3 lines · metro median $161

$161

cash

$75 to $240

35 negotiated rates

$247

list

Psychotherapy, 60 minutes

CPT 90837 · lowest of 3 lines · metro median $150

$150

cash

$110 to $227

35 negotiated rates

$230

list

Removal of a breast lump (biopsy by excision)

CPT 19120 · metro median $870

$870

cash

$181 to $4,632

59 negotiated rates

$1,339

list

Screening mammogram (both breasts)

CPT 77067 · lowest of 9 lines · metro median $74

$74

cash

$81 to $450

123 negotiated rates

$114

list

Shoulder arthroscopy with decompression

CPT 29826 · metro median $733

$733

cash

$144 to $958

40 negotiated rates

$1,127

list

Spinal injection, lower back, no imaging guidance

CPT 62322 · lowest of 2 lines · metro median $793

$793

cash

$340 to $4,035

19 negotiated rates

$1,220

list

Spinal injection, lower back, with imaging guidance

CPT 62323 · metro median $638

$638

cash

$90 to $835

17 negotiated rates

$982

list

TSH test (thyroid)

CPT 84443 · lowest of 4 lines · metro median $111

$111

cash

$17 to $165

44 negotiated rates

$170

list

Tonsils and adenoids removal (under age 12)

CPT 42820 · metro median $5,355

$5,355

cash

$181 to $7,003

40 negotiated rates

$8,239

list

Transvaginal ultrasound

CPT 76830 · lowest of 7 lines · metro median $42

$42

cash

$50 to $735

163 negotiated rates

$65

list

Ultrasound of the abdomen (complete)

CPT 76700 · lowest of 2 lines · metro median $493

$493

cash

$65 to $735

22 negotiated rates

$758

list

Upper endoscopy (EGD)

CPT 43235 · metro median $820

$820

cash

$112 to $1,073

57 negotiated rates

$1,262

list

Upper endoscopy with biopsy

CPT 43239 · metro median $820

$820

cash

$125 to $1,131

57 negotiated rates

$1,262

list

Urinalysis with microscope

CPT 81001 · lowest of 6 lines · metro median $36

$36

cash

$3 to $54

66 negotiated rates

$56

list

Vaginal delivery after a previous cesarean

CPT 59610 · metro median $3,568

$3,568

cash

$181 to $4,666

40 negotiated rates

$5,489

list

Vaginal delivery hospital stay, no complications

MS-DRG 807

—

cash

$7,300 to $9,125

3 negotiated rates

—

list

Vaginal delivery with prenatal and postpartum care

CPT 59400 · metro median $4,053

$4,053

cash

$181 to $5,301

53 negotiated rates

$6,236

list

X-ray of the lower spine (4 or more views)

CPT 72110 · lowest of 3 lines · metro median $377

$152

cash

$32 to $735

62 negotiated rates

$234

list

Source files

The machine-readable files this hospital lists in its cms-hpt.txt. Every price above comes from one of them.

https://tq-consumer-static-prd.turquoise.health/consumer-downloads/machine-readable-files/990262217_samuel-mahelona-memorial-hospital_standardcharges.csv
Samuel Mahelona Memorial Hospital · parsed · tall v3.0.0 · file dated 2026-06-15 · 68.7 MB · 3255 price rows read · read Nov 2026