Emergency visit, highest (level 5) at Samuel Mahelona Memorial Hospital. CPT 99285.
What Samuel Mahelona Memorial Hospital publishes for this service, straight from its standard-charges file, last updated June 15, 2026.
Outpatient / ER
$3,020cash price (self-pay)
$4,646list price
$140–$4,507range 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 |
| Hawaii Medical Service Association | Commercial | $1,600 |
| AlohaCare | Medicare | $2,323 |
| Hawaii Medical Service Association | Medicare | $2,323 |
| Humana | Medicare | $2,323 |
| Kaiser Permanente | Medicare | $2,323 |
| Ohana Health Plan | Medicaid | $2,323 |
| Ohana Health Plan | Medicare | $2,323 |
| UnitedHealthcare | Medicare | $2,323 |
| Devoted Health | Medicare | $2,555 |
| University Health Alliance | Commercial | $3,386 |
| Health Management Network | Commercial | $3,949 |
| Kaiser Permanente | Commercial | $4,181 |
| Hawaii Western Management Group | Commercial | $4,414 |
| MDX Hawaii | PPO | $4,507 |
Inpatient
$3,020cash price (self-pay)
$4,646list price
$3,949–$4,507range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Management Network | Commercial | $3,949 |
| Kaiser Permanente | Commercial | $4,181 |
| MDX Hawaii | PPO | $4,507 |
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