Supplies, drugs & other prices at Kaiser Permanente Moanalua Medical Center

Honolulu, HI · every code in this section with a posted price and a Medicare benchmark.

93 codes. Prices are the hospital's own posted facility charges.

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ProcedureCash priceGross charge× Medicare
2019-ncov diagnostic p (U0001) $87 $116 2.4×
2d tte w or w/o fol w/con,fu (C8924) $975 $1,300 2.4×
Abltj perc cryoabltj img gdn nrv plex/trncl nrv (0442T) $16,190.25 $21,587 1.6×
Abltj perc cryoabltj img gdn uxtr/perph nerve (0440T) $4,709.25 $6,279 2.0×
Admin influenza virus vac (G0008) $87.75 $117 1.6×
Admin pneumococcal vaccine (G0009) $87.75 $117 1.6×
Blood mucoprotein (P2038) $16.50 $22 3.3×
Blood thymol turbidity (P2033) $16.50 $22 3.3×
Cbc without platelet (G0307) $19.50 $26 3.0×
Cbc/diffwbc w/o platelet (G0306) $24 $32 3.1×
Cephalin floculation test (P2028) $16.50 $22 3.3×
Colon ca scrn not hi rsk ind (G0121) $3,452.25 $4,603 3.1×
Colorectal scrn; hi risk ind (G0105) $4,625.25 $6,167 4.2×
Computed tomography, breast, including 3D rendering, when performed, bilateral; with contrast material(s) Non-Facility… (0637T) $1,027.50 $1,370 2.5×
Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast material(s)… (0636T) $652.50 $870 2.3×
Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast, followed by contrast… (0638T) $1,027.50 $1,370 2.5×
Computed tomography, breast, including 3D rendering, when performed, unilateral; with contrast material(s) Non-Facility… (0634T) $547.50 $730 2.6×
Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast material Non-Facility… (0633T) $502.50 $670 4.1×
Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast, followed by contrast… (0635T) $570 $760 2.8×
Congo red blood test (P2029) $16.50 $22 3.3×
Covid-19 lab test non-cdc (U0002) $126.75 $169 2.5×
CYP1A2 (cytochrome P450 family 1, subfamily A, member 2) (eg, drug metabolism) gene analysis, common variants (ie, *1F,… (0031U) $535.50 $714 3.1×
Cyp2d6 full gene sequence (0071U) $1,581 $2,108 2.6×
Cyp2d6 gen com&slct rar vrnt (0070U) $2,010 $2,680 3.0×
Cyp2d6 gen cyp2d6-2d7 hybrid (0072U) $1,341 $1,788 3.0×
Cyp2D6 Gen Cyp2D7-2D6 Hybrid (0073U) $1,341 $1,788 3.0×
Direct refer hospital observ (G0379) $570.75 $761 0.8×
Drug test def 1-7 classes (G0480) $501.75 $669 4.4×
Drug test def 15-21 classes (G0482) $1,008.75 $1,345 5.1×
Drug test def 22+ classes (G0483) $1,254 $1,672 5.1×
Drug test def 8-14 classes (G0481) $795 $1,060 5.1×
Egd flexible transnasal dx w/collj spec br/wa (0652T) $3,070.50 $4,094 1.4×
Eia hiv-1/hiv-2 screen (G0432) $60 $80 3.1×
Elisa hiv-1/hiv-2 screen (G0433) $57 $76 3.1×
Endovascular Venous Arterialization Tibl/Prnl Vn (0620T) $102,687 $136,916 2.0×
Fecal blood scrn immunoassay (G0328) $78.75 $105 4.4×
Fern test (Q0114) $37.50 $50 3.9×
Hair analysis (P2031) $16.50 $22 3.3×
Hdr electronic brachytherapy ntrstl/intrcav (0395T) $2,070.75 $2,761 2.5×
Hep c screen high risk/other (G0472) $150 $200 3.2×
Hiv combination assay (G0475) $74.25 $99 3.1×
Hospital outpt clinic visit (G0463) $163.50 $218 1.0×
Hpv combo assay ca screen (G0476) $117.75 $157 3.4×
Init/sub psych care m 1st 30 (G2214) $246.75 $329 2.1×
Inj for sacroiliac jt anesth (G0260) $2,031.75 $2,709 2.4×
Insertion wrls car stimulator lv pacg compl sys (0515T) $38,035.50 $50,714 1.4×
Insertion/replacement iims implantable mntr only (0527T) $13,708.50 $18,278 1.4×
Insj/Rplcmt Icds W/Substernal Electrode (0571T) $34,857 $46,476 0.9×
Jak2 Gene Analysis Trgt Seq Alys Exons 12-15 (0027U) $363 $484 3.0×
Liver Dis 10 Assays W/Nash (0003M) $1,497.75 $1,997 3.0×
Liver disease, ten biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, haptoglobin,… (0002M) $1,497.75 $1,997 3.0×
Lpoprtn bld w/5 maj class auto prfl ucentrfugtn (0052U) $100.50 $134 3.0×
Neuro csf prion prtn qual (0035U) $1,656.75 $2,209 3.1×
Njx pltlt plasma w/img harvest/preparation (0232T) $990.75 $1,321 1.9×
Onc aml DNA gntyp int tandem dup detcj/nondetcj (0023U) $738.75 $985 3.0×
Onc brst dux carc is mrna 12 genes alg rsk scor (0045U) $11,517 $15,356 3.0×
Onc Merkel Cll Carc Srm Quan (0058U) $989.25 $1,319 3.1×
Onc prst8 mrna gen xprs prfl 17 gen alg rsk scor (0047U) $11,517 $15,356 3.0×
Oncology (gastrointestinal neuroendocrine tumors), real-time PCR expression analysis of 51 genes, utilizing whole… (0007M) $1,115.25 $1,487 3.0×
Oncology (hepatic), mRNA expression levels of 161 genes, utilizing fresh hepatocellular carcinoma tumor tissue, with… (0006M) $445.50 $594 3.0×
Oral hiv-1/hiv-2 screen (G0435) $36.75 $49 3.1×
Pathogen test for platelets (P9100) $164.25 $219 2.4×
Perc d-e cor revasc chro sin (C9607) $23,970.75 $31,961 1.1×
Perc d-e cor revasc t cabg s (C9604) $11,535 $15,380 0.8×
Perc d-e cor stent ather s (C9602) $26,080.50 $34,774 1.2×
Perc drug-el cor stent sing (C9600) $23,668.50 $31,558 1.7×
Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral… (0629T) $36,221.25 $48,295 2.4×
Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral… (0627T) $36,221.25 $48,295 2.4×
Perq Sacral Augmt Bilat Inj (0201T) $9,420 $12,560 1.1×
Perq Sacral Augmt Unilat Inj (0200T) $9,420 $12,560 1.1×
Pinworm examinations (Q0113) $13.50 $18 3.2×
Place device/marker, non pro (C9728) $3,445.50 $4,594 2.1×
Pne flu hepb cov home admin (M0201) $98.25 $131 2.3×
Post-coital mucous exam (Q0115) $77.25 $103 3.1×
Potassium hydroxide preps (Q0112) $21.75 $29 3.7×
Prostate biopsy, any mthd (G0416) $837 $1,116 2.0×
Psa screening (G0103) $123 $164 6.4×
Revasc intravasc lithotripsy (C9764) $19,527 $26,036 1.4×
Revasc lith-sten-ath tib/per (C9775) $45,417 $60,556 2.1×
Revasc lithotr-ather tib/per (C9774) $45,417 $60,556 2.1×
Revasc lithotr-stent tib/per (C9773) $45,417 $60,556 2.1×
Revasc lithotrip tibi/perone (C9772) $28,395 $37,860 2.1×
Scoliosis, DNA analysis of 53 single nucleotide polymorphisms (SNPs), using saliva, prognostic algorithm reported as a… (0004M) $234.75 $313 3.0×
Scr c/v cyto,thinlayer,rescr (G0145) $90 $120 3.4×
Screen cerv/vag thin layer (G0123) $123.75 $165 6.1×
Semen analysis (G0027) $19.50 $26 3.0×
Single energy x-ray study (G0130) $296.25 $395 2.4×
Tomosynthesis, mammo (G0279) $102.75 $137 8.1×
Trgt gen seq alys sld orgn neo DNA 324 genes (0037U) $10,409.25 $13,879 3.0×
Unsched dialysis esrd pt hos (G0257) $825 $1,100 1.0×
Ven blood coll snf/hha (G0471) $30 $40 2.6×
Warfarin respon genetic test (G9143) $372.75 $497 3.1×
Wet mounts/ w preparations (Q0111) $54 $72 2.9×