Emergency visit, high (level 4) at Samuel Mahelona Memorial Hospital. CPT 99284.
What Samuel Mahelona Memorial Hospital publishes for this service, straight from its standard-charges file, last updated June 15, 2026.
Outpatient / ER
$1,957cash price (self-pay)
$3,010list price
$140–$2,920range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| AlohaCare | Medicaid | $140 |
| Hawaii Medical Service Association | Non-ABD | $450 |
| Hawaii Medical Service Association | ABD | $469 |
| Kaiser Permanente | Medicaid | $938 |
| AlohaCare | Medicare | $1,505 |
| Hawaii Medical Service Association | Medicare | $1,505 |
| Humana | Medicare | $1,505 |
| Kaiser Permanente | Medicare | $1,505 |
| Ohana Health Plan | Medicaid | $1,505 |
| Ohana Health Plan | Medicare | $1,505 |
| UnitedHealthcare | Medicare | $1,505 |
| Hawaii Medical Service Association | Commercial | $1,600 |
| Devoted Health | Medicare | $1,656 |
| University Health Alliance | Commercial | $2,194 |
| Health Management Network | Commercial | $2,559 |
| Kaiser Permanente | Commercial | $2,709 |
| Hawaii Western Management Group | Commercial | $2,860 |
| MDX Hawaii | PPO | $2,920 |
Inpatient
$1,957cash price (self-pay)
$3,010list price
$2,559–$2,920range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Management Network | Commercial | $2,559 |
| Kaiser Permanente | Commercial | $2,709 |
| MDX Hawaii | PPO | $2,920 |
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