Does Samuel Mahelona Memorial Hospital publish its standard charges and chargemaster?

Yes. Samuel Mahelona Memorial Hospital publishes a machine-readable file with 6,207 standard-charge rows — gross charges, cash prices, and payer-negotiated rates, earning a CMS price transparency compliance grade of A. Browse the negotiated rates by procedure and payer on this page.

How much does Samuel Mahelona Memorial Hospital charge for procedures?

Samuel Mahelona Memorial Hospital (Kapaa Kauai, HI) publishes a separately negotiated rate for each insurance payer, plus a discounted cash price and a gross (list) charge, for every procedure in its price transparency file. This page compares each procedure's negotiated median against the national median so you can see whether a price is above or below market.

▸ Hospital · HI · CCN 121306

Samuel Mahelona Memorial Hospital

Kapaa Kauai, HI, 96746

5 bedsCritical Access Hospitals10

Compliance grade

92/100

Rates published

6,207

last crawl 2026-05-23

Procedures tracked

of 209 target codes

Payers

with negotiated rates

Procedures tracked

...

Payers

...

▸ Compare with other hospitals All HI hospitalsJSON

The report bundles all published codes × every payer rate + compliance grade as a downloadable PDF + CSV with a data-version manifest.

Source MRF: https://www.hhsc.org/standardcharge/smmh/99-0262217_Samuel-Mahelona-Memorial-Hospital_standardcharges.csv · CSV

Procedures & rates

vs nat'l shows this hospital's negotiated median against the national median for that code (green = at/below market, amber = 1–1.5×, red = >1.5× the national median).

Procedure	Type	Code	Payers	Gross	Cash	Neg min	Neg median	vs nat'l	Neg max
behavioral
Psychoses	MS-DRG	885	1	—	—	$15,004	$15,004	1.2×	$15,004
emergency
ED visit level 1	CPT	99281	2	$466	$302.9	$390	$703.25	5.0×	$1,400
ED visit level 2	CPT	99282	2	$853	$554.45	$390	$703.25	3.0×	$1,400
ED visit level 3	CPT	99283	2	$1,359	$883.35	$390	$703.25	1.7×	$1,400
ED visit level 4	CPT	99284	2	$4,950	$3,217.5	$390	$703.25	1.1×	$1,400
ED visit level 5	CPT	99285	2	$3,292	$2,139.8	$390	$703.25	0.67×	$1,400
Critical care, first hour	CPT	99291	2	$4,310	$2,801.5	$390	$703.25	0.66×	$1,400
imaging
CT head without contrast	CPT	70450	5	$1,525	$991.25	$139.1	$208.44	1.0×	$410.4
CT head with and without contrast	CPT	70470	5	$2,016.67	$1,310.84	$232.9	$364.13	1.4×	$625.53
CT neck with contrast	CPT	70491	5	$2,061	$1,339.65	$186.48	$411.48	1.5×	$544.9
Chest X-ray single view	CPT	71045	3	$365	$237.25	$13.07	$17.41	0.18×	$34.31
Chest X-ray 2 views	CPT	71046	3	$415	$269.75	$20.37	$23.07	0.23×	$45.45
Chest X-ray 3 views	CPT	71047	3	$448	$291.2	$24.39	$27.67	0.29×	$54.53
CT chest without contrast	CPT	71250	5	$1,525	$991.25	$194.84	$320.07	1.5×	$518.82
CT chest with contrast	CPT	71260	5	$2,137	$1,389.05	$232.9	$476.77	1.7×	$627.23
Lumbosacral spine X-ray	CPT	72100	5	$458	$297.7	$21.96	$49.03	0.47×	$67.11
CT cervical spine without contrast	CPT	72125	5	$1,400	$910	$194.84	$320.07	1.6×	$518.82
CT thoracic spine without contrast	CPT	72128	5	$1,400	$910	$194.84	$320.07	1.6×	$518.82
CT lumbar spine without contrast	CPT	72131	5	$1,050	$682.5	$177.96	$320.07	1.6×	$518.82
CT pelvis without contrast	CPT	72192	5	$1,066.67	$693.34	$194.84	$259.65	1.3×	$510.29
CT pelvis with contrast	CPT	72193	5	$1,481	$962.65	$225.48	$478.81	1.7×	$603.64
Shoulder X-ray	CPT	73030	5	$416	$270.4	$18.84	$41.94	0.45×	$54.83
Humerus X-ray	CPT	73060	5	$348	$226.2	$18.84	$41.94	0.47×	$57.91
Hand X-ray 3 views	CPT	73130	5	$416	$270.4	$19.08	$38.5	0.41×	$61.99
Knee X-ray 1-2 views	CPT	73560	5	$348	$226.2	$17.04	$37.81	0.41×	$64.03
Ankle X-ray 3 views	CPT	73610	5	$381	$247.65	$17.34	$38.5	0.42×	$64.03
CT abdomen with and without contrast	CPT	74170	5	$1,578	$1,025.7	$279.37	$548.46	1.6×	$805.52
CT abdomen and pelvis without contrast	CPT	74176	4	$2,600	$1,690	$94.66	$305.97	0.84×	$841.23
CT abdomen and pelvis with contrast	CPT	74177	4	$3,350	$2,177.5	$180.62	$523.64	0.95×	$996.6
CT abdomen and pelvis with and without contrast	CPT	74178	4	$3,500	$2,275	$238.75	$663.51	1.2×	$1,233.65
Abdominal ultrasound complete	CPT	76700	5	$722	$469.3	$64.94	$145.93	0.98×	$237.12
Abdominal ultrasound limited	CPT	76705	5	$649	$421.85	$46.98	$109.94	0.75×	$177.71
Retroperitoneal ultrasound complete	CPT	76770	5	$722	$469.3	$64.94	$144.61	1.0×	$219.7
Obstetric ultrasound first trimester	CPT	76801	5	$722	$469.3	$55.49	$131.39	0.93×	$211.51
Obstetric ultrasound after first trimester	CPT	76805	5	$725	$471.25	$61.23	$153.11	1.0×	$263.76
Transvaginal ultrasound	CPT	76830	5	$722	$469.3	$50.35	$125.68	0.85×	$251.46
Pelvic ultrasound complete	CPT	76856	5	$772	$501.8	$50.35	$126.3	0.88×	$217.66
Scrotal ultrasound	CPT	76870	5	$725	$471.25	$50.35	$101.94	0.78×	$170.14
EKG tracing only	CPT	93005	3	$256	$166.4	$15.16	$31.7	0.27×	$36.14
inpatient
Respiratory infections & inflammations w MCC	MS-DRG	177	1	—	—	$40,112	$40,112	2.6×	$40,112
COPD w MCC	MS-DRG	190	1	—	—	$17,596	$17,596	1.6×	$17,596
COPD w CC	MS-DRG	191	1	—	—	$17,596	$17,596	2.0×	$17,596
COPD w/o CC/MCC	MS-DRG	192	1	—	—	$17,596	$17,596	2.5×	$17,596
Simple pneumonia & pleurisy w CC	MS-DRG	194	1	—	—	$22,644	$22,644	2.7×	$22,644
Simple pneumonia & pleurisy w/o CC/MCC	MS-DRG	195	1	—	—	$18,024	$18,024	2.7×	$18,024
AMI discharged alive w MCC	MS-DRG	280	1	—	—	$31,850	$31,850	2.0×	$31,850
AMI discharged alive w CC	MS-DRG	281	1	—	—	$27,538	$27,538	2.8×	$27,538
AMI discharged alive w/o CC/MCC	MS-DRG	282	1	—	—	$24,115	$24,115	3.1×	$24,115
Heart failure & shock w MCC	MS-DRG	291	1	—	—	$27,143	$27,143	2.1×	$27,143
Heart failure & shock w CC	MS-DRG	292	1	—	—	$27,143	$27,143	3.0×	$27,143
Heart failure & shock w/o CC/MCC	MS-DRG	293	1	—	—	$27,143	$27,143	4.4×	$27,143
Cardiac arrhythmia w MCC	MS-DRG	308	1	—	—	$20,097	$20,097	1.7×	$20,097
Cardiac arrhythmia w CC	MS-DRG	309	1	—	—	$18,861	$18,861	2.4×	$18,861
Cardiac arrhythmia w/o CC/MCC	MS-DRG	310	1	—	—	$14,456	$14,456	2.3×	$14,456
GI hemorrhage w CC	MS-DRG	378	1	—	—	$20,328	$20,328	2.0×	$20,328
GI hemorrhage w/o CC/MCC	MS-DRG	379	1	—	—	$15,588	$15,588	2.3×	$15,588
Esophagitis/gastroenteritis w/o MCC	MS-DRG	392	1	—	—	$13,856	$13,856	1.7×	$13,856
Fractures of femur w/o MCC	MS-DRG	533	1	—	—	$11,607	$11,607	0.76×	$11,607
Kidney/UTI w MCC	MS-DRG	689	1	—	—	$16,696	$16,696	1.4×	$16,696
Kidney/UTI w/o MCC	MS-DRG	690	1	—	—	$14,255	$14,255	1.7×	$14,255
Septicemia or severe sepsis w MV 96+ hrs	MS-DRG	871	1	—	—	$38,856	$38,856	2.1×	$38,856
Septicemia or severe sepsis w/o MV 96+ hrs	MS-DRG	872	1	—	—	$38,835	$38,835	3.7×	$38,835
lab
Basic metabolic panel (BMP)	CPT	80048	5	$107	$69.55	$11.7	$20.08	0.62×	$23.9
Electrolyte panel	CPT	80051	5	$74	$48.1	$9.69	$16.64	0.70×	$19.8
Comprehensive metabolic panel	CPT	80053	5	$133	$86.45	$14.61	$25.1	0.56×	$29.84
Lipid panel	CPT	80061	5	$143	$92.95	$18.51	$31.76	0.83×	$37.81
Renal function panel	CPT	80069	5	$103	$66.95	$12	$20.63	0.76×	$24.5
Hepatic function panel	CPT	80076	5	$110	$71.5	$11.29	$19.39	0.73×	$23.07
Urinalysis non-automated	CPT	81002	5	$20	$13	$3.54	$6.05	0.87×	$7.21
Glucose quantitative	CPT	82947	5	$42	$27.3	$5.42	$9.29	0.53×	$11.07
Hemoglobin A1c	CPT	83036	5	$116	$75.4	$13.42	$23.04	0.86×	$27.39
Thyroid stimulating hormone (TSH)	CPT	84443	5	$223	$144.95	$23.21	$39.88	0.84×	$47.41
Complete blood count with automated differential	CPT	85025	5	$104	$67.6	$10.74	$18.43	0.70×	$21.94
Complete blood count without differential	CPT	85027	5	$79	$51.35	$8.95	$15.34	0.71×	$18.26
Urine culture bacterial	CPT	87086	5	$89	$57.85	$11.16	$19.19	0.82×	$22.79
Urine culture identification	CPT	87088	5	$92	$59.8	$10.55	$18.15	0.81×	$21.55
surgery
Major small/large bowel procedures w MCC	MS-DRG	329	1	—	—	$76,687	$76,687	1.8×	$76,687
Major small/large bowel procedures w CC	MS-DRG	330	1	—	—	$62,081	$62,081	2.7×	$62,081
Major small/large bowel procedures w/o CC/MCC	MS-DRG	331	1	—	—	$34,772	$34,772	2.1×	$34,772
Laparoscopic cholecystectomy w/o CDE w MCC	MS-DRG	418	1	—	—	$25,687	$25,687	1.6×	$25,687
Laparoscopic cholecystectomy w/o CDE w CC	MS-DRG	419	1	—	—	$16,617	$16,617	1.2×	$16,617
Laparoscopic cholecystectomy w/o CDE w/o CC/MCC	MS-DRG	420	1	—	—	$62,316	$62,316	1.9×	$62,316
Spinal fusion (non-cervical) w MCC	MS-DRG	459	1	—	—	$80,196	$80,196	1.6×	$80,196
Spinal fusion (non-cervical) w/o MCC	MS-DRG	460	1	—	—	$75,463	$75,463	2.2×	$75,463
Major joint replacement w MCC	MS-DRG	469	1	—	—	$38,988	$38,988	1.3×	$38,988
Major joint replacement w/o MCC	MS-DRG	470	1	—	—	$26,470	$26,470	1.4×	$26,470
Hip & femur procedures except major joint w MCC	MS-DRG	480	1	—	—	$47,362	$47,362	1.7×	$47,362
Hip & femur procedures except major joint w CC	MS-DRG	481	1	—	—	$46,189	$46,189	2.3×	$46,189
Hip & femur procedures except major joint w/o CC/MCC	MS-DRG	482	1	—	—	$33,285	$33,285	2.1×	$33,285
OR procedure for obesity w MCC	MS-DRG	619	1	—	—	$49,231	$49,231	1.8×	$49,231
OR procedure for obesity w CC	MS-DRG	620	1	—	—	$49,231	$49,231	3.0×	$49,231
OR procedure for obesity w/o CC/MCC	MS-DRG	621	1	—	—	$49,017	$49,017	3.2×	$49,017
Uterine & adnexa procedures w CC/MCC	MS-DRG	743	1	—	—	$19,063	$19,063	1.6×	$19,063
Uterine & adnexa procedures w/o CC/MCC	MS-DRG	744	1	—	—	$14,896	$14,896	0.78×	$14,896

Rate history available after the next quarterly refresh. We re-crawl all hospital MRFs each quarter to track rate changes over time.

Payer mix (top 6)

Payer	Codes covered	Median rate
hmsa	94	$179.29
UnitedHealthcare	46	$24.68
uha	45	$58.13
hma	42	$139.83
hmaa	40	$54.82
Kaiser Permanente	6	$937.5

Related data on other Healthparse brands

Explore this hospital across cost reports, quality ratings, and non-profit filings.

HCRIS.io

Medicare cost reports, margins, utilization

Stetho.io

SNF, HHA, hospice, dialysis cost reports + ownership

990Health

IRS Form 990 financials, executive compensation

CareLens

CMS quality ratings, inspections, staffing