How many shoppable procedure prices are published for Samuel Mahelona Memorial Hospital?

Samuel Mahelona Memorial Hospital in Kapaa, HI currently has 113 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do Samuel Mahelona Memorial Hospital's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, Samuel Mahelona Memorial Hospital's median negotiated commercial rate is 0.8× the regionally adjusted fair BaseRate benchmark.

Hospital Profile Critical Access Hospital Government - State 5 Beds · rural Updated: 2026-06-15

Samuel Mahelona Memorial Hospital

4800 Kawaihau Road, Kapaa, HI 96746 · 113 Priced Procedures

CMS Overall Rating No CMS Rating

Good Deal · Below Fair Market

0.85×vs. Fair Market Price

Typical commercial prices here are 15% below the fair benchmark (0.85×) after accounting for local nurse/doctor wages and patient complexity.

73/100 · Corroborated

73/100Self-Pay Cash Beats Insurance 55% of the Time

File Completeness66

Price Logic78

Peer Alignment59

Clean Billing65

Real Cash Discount100

Regional Value Leader

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

Behavioral Pricing FingerprintMedian-Gamed · High Captive Markup

Loss-Leader / Captive Ancillary Cross-Subsidizer

Samuel Mahelona Memorial Hospital prices routine shoppable procedures near 0.6× Medicare (p50 0.70×) while skewing captive emergency, lab, and upper-quartile codes to 1.5× Medicare (p75 1.27×, +81% upper-tail jump). Patients scheduling elective outpatient care can capture competitive rates, but emergency and ancillary bills require strict line-item auditing.

#4 of 20 in HI · 15th State Percentile#424 of 3,385 in U.S. · 12th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Elective shoppable care is priced 15% below peer Fair BaseRate (0.85×)
Self-pay cash beats commercial insurance on 55% of shoppable procedures (99/100 Cash Honesty)
CMS clinical safety score (85/100 safety score) with 72% patient recommendation
Binding Good Faith Estimate rights under 45 CFR § 149.610 protect self-pay patients before scheduling

Watchout

Where You Can Get Burned (Markup Traps)

Even at low-cost facilities (0.85× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
Captive ER (0.9×) & laboratory (2.1×) services average 2.50× higher multiples than routine shoppable care (0.6×)
Upper-quartile procedures (Q75 1.27×) jump +81% above the median procedure ratio (Q50 0.70×)
Consolidated metro market (HHI 6,208) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))

Front-Door ShoppableElective / Imaging

0.6× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER2.50× Divergence

1.5× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+81% Upper Tail

Q25 0.43× · Q50 0.70× · Q75 1.27×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.

Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×

Front-Door Shoppable CareFront-Door Shoppable

0.6× MedicareGood

Outpatient Surgery & ORBack-Door Captive

0.8× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

0.6× MedicareGood

Back-Door Captive ER VisitsBack-Door Captive

0.9× MedicareGood

Inpatient Lab & PathologyBack-Door Captive

2.1× MedicareGood

Specialty & Infusion Drugs (J-Codes)Back-Door Captive

0.7× MedicareGood

Self-Pay Cash Honesty & 501(r)Integrity & Outcomes

55% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

3 CMS · 85/100Good

Procedure Prices at Samuel Mahelona Memorial Hospital

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 113 published procedures.

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Audit a Bill & 501(r) Cap ↓

Procedure & Billing Code	Self-Pay Cash	This Hospital	Fair BaseRate	vs. Fair
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	—	$40,815	$19,087	2.1×
Heart stent placement (inpatient stay) MS-DRG Code: `322`	—	$40,483	$17,936	unverified
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	—	$19,101	$19,432	1.0×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	—	$14,553	$8,223	1.8×
Total hip replacement CPT Code: `27130`	$11,614	$11,614	$13,413	0.9×
Total knee replacement CPT Code: `27447`	$11,614	$11,614	$13,523	0.9×
Gallbladder removal (laparoscopic) CPT Code: `47562`	$3,589	$3,589	$6,109	0.6×
C-section delivery (full package) CPT Code: `59510`	$4,449	$2,638	$2,975	unverified
Vaginal delivery (full package) CPT Code: `59400`	$4,053	$2,388	$2,680	0.9×
Breast lump removal CPT Code: `19120`	$2,206	$2,206	$3,875	0.6×
Cataract surgery with lens implant CPT Code: `66984`	$2,088	$570	$2,540	0.2×
Knee arthroscopy with meniscus repair CPT Code: `29881`	$2,960	$569	$3,372	0.2×
Bunion correction surgery CPT Code: `28296`	$2,960	$548	$3,446	0.2×
Inguinal hernia repair CPT Code: `49505`	$3,239	$526	$3,629	0.1×
MRI, knee or other leg joint CPT Code: `73721`	$1,132	$396	$369	1.1×
Speech therapy (language evaluation) CPT Code: `92507`	$267	$267	$86	3.1×
Breathing treatment (nebulizer) CPT Code: `94640`	$278	$278	$201	1.4×
Blood transfusion CPT Code: `36430`	$1,338	$298	$498	0.6×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$2,287	$269	$448	0.6×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$1,976	$216	$583	0.4×
Orthotic fitting and training CPT Code: `97760`	$183	$183	$51	3.6×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$442	$183	$272	0.7×
Colonoscopy (diagnostic) CPT Code: `45378`	$792	$184	$981	0.2×
Colonoscopy with biopsy CPT Code: `45380`	$1,082	$200	$1,256	0.2×
CT scan, chest (no contrast) CPT Code: `71250`	$1,047	$139	$167	0.8×
Psychiatric evaluation (first visit) CPT Code: `90791`	$293	$148	$185	0.8×
Psychotherapy session (60 minutes) CPT Code: `90837`	$150	$136	$181	0.8×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$1,775	$161	$303	0.5×
CT scan, head (with and without contrast) CPT Code: `70470`	$767	$118	$258	0.5×
Upper endoscopy with biopsy CPT Code: `43239`	$842	$139	$987	0.1×
CT scan, sinuses CPT Code: `70486`	$3,027	$137	$166	unverified
X-ray, pelvis CPT Code: `72170`	$100	$100	$110	0.9×
New patient office visit (30-44 min) CPT Code: `99203`	$173	$82	$110	0.7×
Office visit, established patient (30-39 min) CPT Code: `99214`	$324	$89	$123	0.7×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$521	$105	$148	0.7×
Screening mammogram (both breasts) CPT Code: `77067`	$114	$85	$123	0.7×
Family therapy session CPT Code: `90847`	$161	$104	$173	0.6×
Psychotherapy session (45 minutes) CPT Code: `90834`	$161	$92	$166	0.6×
CT scan, pelvis CPT Code: `72192`	$728	$90	$163	0.6×
CT scan, neck (cervical spine) CPT Code: `72125`	$956	$88	$169	0.5×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$717	$87	$168	0.5×
CT scan, head (with contrast) CPT Code: `70460`	$1,011	$100	$242	0.4×
Hospital observation (per hour) HCPCS Code: `G0378`	$106	$106	$86	unverified
Drug screening test HCPCS Code: `G0480`	$153	$96	$116	0.8×
Office visit, established patient (20-29 min) CPT Code: `99213`	$317	$61	$87	0.7×
Care planning with family CPT Code: `90887`	$153	$71	$107	0.7×
Ultrasound, abdomen (complete) CPT Code: `76700`	$298	$65	$134	0.5×
CT scan, head (no contrast) CPT Code: `70450`	$1,041	$72	$160	0.5×
Varicella (chickenpox) vaccine HCPCS Code: `90716`	$76	$76	$203	0.4×
Blood test, vitamin D CPT Code: `82306`	$206	$41	$31	1.3×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$184	$39	$56	0.7×
Ultrasound, abdomen (limited) CPT Code: `76705`	$460	$54	$126	0.4×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$44	$44	$111	0.4×
Ultrasound, pelvis CPT Code: `76856`	$496	$50	$130	0.4×
Ultrasound, thyroid and neck CPT Code: `76536`	$429	$47	$132	0.4×
Pneumococcal vaccine HCPCS Code: `90732`	$50	$50	$140	unverified
Blood test, lipase CPT Code: `83690`	$61	$10	$7	1.4×
Blood test, calcium CPT Code: `82310`	$50	$7	$5	1.4×
Blood test, creatinine (kidney) CPT Code: `82565`	$41	$7	$5	1.4×
Blood test, sodium CPT Code: `84295`	$146	$7	$5	1.4×
Blood test, complete blood count (CBC) CPT Code: `85025`	$74	$11	$8	1.4×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$100	$19	$14	1.4×
Blood test, basic metabolic panel CPT Code: `80048`	$76	$12	$9	1.3×
Blood test, vitamin B12 CPT Code: `82607`	$112	$21	$16	1.3×
Blood test, amylase CPT Code: `82150`	$63	$9	$7	1.3×
Blood test, liver function panel CPT Code: `80076`	$78	$11	$9	1.2×
X-ray, hip CPT Code: `73502`	$203	$30	$93	0.3×
X-ray, lower back CPT Code: `72110`	$322	$34	$112	0.3×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$36	$4	$3	1.3×
Blood test, clotting time (PTT) CPT Code: `85730`	$54	$8	$6	1.3×
Hepatitis C antibody test CPT Code: `86803`	$106	$20	$15	1.3×
Culture, bacterial CPT Code: `87070`	$69	$12	$9	1.3×
Blood test, PSA (prostate screen) CPT Code: `84153`	$90	$25	$19	1.3×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$83	$13	$10	1.3×
Blood test, glucose (blood sugar) CPT Code: `82947`	$32	$5	$4	1.3×
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$94	$24	$20	1.2×
Blood test, ferritin (iron stores) CPT Code: `82728`	$80	$16	$14	1.1×
Flu vaccine injection HCPCS Code: `G0008`	$70	$35	$48	0.7×
Pneumonia vaccine injection HCPCS Code: `G0009`	$73	$35	$49	0.7×
Blood test, magnesium CPT Code: `83735`	$67	$9	$7	1.3×
Culture, blood CPT Code: `87040`	$83	$14	$11	1.3×
Hepatitis B vaccine HCPCS Code: `90744`	$25	$33	$37	unverified
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$36	$5	$4	1.3×
Blood test, potassium CPT Code: `84132`	$146	$6	$5	1.2×
Blood test, hemoglobin CPT Code: `85018`	$18	$3	$3	1.0×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$44	$5	$5	1.0×
Electrical stimulation therapy HCPCS Code: `G0283`	$45	$13	$14	0.9×
Extended office visit (prolonged) HCPCS Code: `G2212`	$55	$30	$33	0.9×
Electrocardiogram (ECG/EKG) CPT Code: `93000`	$39	$16	$25	0.6×
Physical therapy (manual therapy) CPT Code: `97140`	$120	$21	$34	0.6×
Physical therapy (functional capacity test) CPT Code: `97750`	$164	$20	$38	0.5×
Physical therapy (gait training) CPT Code: `97116`	$155	$17	$33	0.5×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$129	$18	$35	0.5×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$173	$19	$38	0.5×
Occupational therapy (self-care training) CPT Code: `97535`	$143	$19	$38	0.5×
DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: `90700`	$85	$18	$39	0.5×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$180	$18	$40	0.5×
Blood antibody screen CPT Code: `86850`	$129	$20	$46	0.4×
Speech therapy (group session) CPT Code: `92508`	$115	$11	$27	0.4×
Prosthetic fitting and training CPT Code: `97761`	$169	$18	$45	0.4×
Colorectal cancer screening HCPCS Code: `G0010`	$16	$16	$49	0.3×
X-ray, hand CPT Code: `73130`	$231	$25	$93	0.3×
X-ray, neck (cervical spine) CPT Code: `72040`	$221	$24	$93	0.3×
X-ray, chest (two views) CPT Code: `71046`	$187	$23	$93	0.2×
Group therapy session CPT Code: `90853`	$92	$24	$100	0.2×
X-ray, shoulder CPT Code: `73030`	$115	$20	$92	0.2×
X-ray, foot CPT Code: `73630`	$114	$20	$92	0.2×
X-ray, ankle CPT Code: `73610`	$119	$18	$93	0.2×
X-ray, chest (single view) CPT Code: `71045`	$170	$17	$92	0.2×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$241	$9	$64	0.1×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$92	$15	$11	unverified
Blood test, thyroid (TSH) CPT Code: `84443`	$111	$23	$18	unverified
Flu vaccine (high dose) HCPCS Code: `90656`	$63	$23	$25	unverified

Showing top 25 high-impact procedures of 113 total

Inline Bill X-Ray & 501(r) Calculator For-Profit Facility · Cash & Fair BaseRate Audit

Audit a Bill or Quote at Samuel Mahelona Memorial Hospital (Zero PHI Required)

CMS CCN: 121306

CPT 871

Select Procedure to Audit:

Fair BaseRate™ $19,087

Medicare Rate $14,117

Self-Pay Cash Request Quote

Insurer Median $40,815

1. Amount on Your Bill or Quote ($) Pre-filled with Samuel Mahelona Memorial Hospital’s charged/list benchmark

2. Household Annual Income ($) Screened against 2026 HHS Federal Poverty Guidelines

3. Household Size (1–8) 2026 FPL: $15,650 + $5,500 per additional person

Step 1 · 501(r) Charity Care Check 274% of 2026 FPL

Above Standard 400% FPL Financial-Assistance Ceiling

At 274% FPL, you exceed the standard 400% FPL tier, though medical-hardship caps (when bills exceed 10% of annual income) may still apply.

Step 2 · Cash vs. Insurance Arbitrage Request Prompt-Pay Quote

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask Samuel Mahelona Memorial Hospital's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.

Step 3 · Fair BaseRate Target +$78,869 Above Fair BaseRate

Negotiate Toward $19,087 Fair BaseRate ($14,117 Medicare)

Your bill ($97,956) is $78,869 above the denoised Fair BaseRate ($19,087) and 6.9× the $14,117 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.

IRS Form 990 Schedule H & 26 U.S.C. § 501(r) For-Profit / Non-501(c)(3)

Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)

Public IRS & CMS ownership records classify Samuel Mahelona Memorial Hospital as a non-501(c)(3) facility. Federal 26 U.S.C. § 501(r) statutory charity-care caps apply specifically to tax-exempt nonprofit hospitals, though state hospital fair-pricing statutes and prompt-pay self-pay discounts may still apply.

Screen your household size, income, and itemized CPT codes against 2026 HHS Federal Poverty Guidelines: Calculate Your 501(r) Cap Above ↑

CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

Safety Composite85/100

Median ER Wait59 min

Left ER Before Seen0%

Source: CMS Hospital Care Compare. Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Regional Quality & Price Benchmark

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Samuel Mahelona Memorial Hospital.

Price Index: 1.03× regional baseline

Quality: 57/100 CMS composite

Median Household Income$93,612U.S. Census ACS

Local Uninsured Share4.1%Regional ACS estimate

200% FPL (1 Person)$36,720Common free-care ceiling

400% FPL (Family of 4)$147,920Common AGB cap ceiling

45 CFR § 180 Primary-Source Lineage & Federal Verification VeriRate 73/100 · Corroborated CMS CCN 121306

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

MRF Portal Indexed (CMS_45_CFR_180_FILING.json) Verify on CMS Medicare.gov (CCN 121306) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileCMS_45_CFR_180_FILING.json

Publication / Vintage2026-06-15

Validated Rate Rows4,588 (CMS v3.0.0)

File Integrity DigestVerified · CCN 121306

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy