Emergency visit, moderate (level 3) at Samuel Mahelona Memorial Hospital. CPT 99283.
What Samuel Mahelona Memorial Hospital publishes for this service, straight from its standard-charges file, last updated June 15, 2026.
Outpatient / ER
$1,091cash price (self-pay)
$1,678list price
$140–$1,628range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| AlohaCare | Medicaid | $140 |
| Hawaii Medical Service Association | Non-ABD | $450 |
| Hawaii Medical Service Association | ABD | $469 |
| AlohaCare | Medicare | $839 |
| Hawaii Medical Service Association | Medicare | $839 |
| Humana | Medicare | $839 |
| Kaiser Permanente | Medicare | $839 |
| Ohana Health Plan | Medicaid | $839 |
| Ohana Health Plan | Medicare | $839 |
| UnitedHealthcare | Medicare | $839 |
| Devoted Health | Medicare | $923 |
| Kaiser Permanente | Medicaid | $938 |
| University Health Alliance | Commercial | $1,223 |
| Health Management Network | Commercial | $1,426 |
| Kaiser Permanente | Commercial | $1,510 |
| Hawaii Western Management Group | Commercial | $1,594 |
| Hawaii Medical Service Association | Commercial | $1,600 |
| MDX Hawaii | PPO | $1,628 |
Inpatient
$1,091cash price (self-pay)
$1,678list price
$1,426–$1,628range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Management Network | Commercial | $1,426 |
| Kaiser Permanente | Commercial | $1,510 |
| MDX Hawaii | PPO | $1,628 |
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