Supplies, drugs & other prices at Pali Momi Medical Center
Aiea, HI · every code in this section with a posted price and a Medicare benchmark.
72 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 2d tee w or w/o fol w/con,in (C8925) range across 2 matching MRF lines |
$1,242.60–$1,356 | $2,071–$2,260 | varies |
| 2d tte w or w/o fol w/con,fu (C8924) range across 2 matching MRF lines |
$692.40–$805.20 | $1,154–$1,342 | varies |
| Admin influenza virus vac (G0008) | $72.60 | $121 | 1.3× |
| Admin pneumococcal vaccine (G0009) | $72.60 | $121 | 1.3× |
| Adv prim care mgmt lvl 1 (G0556) | $11.40 | $19 | 0.3× |
| Adv prim care mgmt lvl 2 (G0557) | $37.20 | $62 | 0.8× |
| Adv prim care mgmt lvl 3 (G0558) | $80.40 | $134 | 0.7× |
| Alcohol/sub misuse assess (G2011) | $36 | $60 | 1.1× |
| Alcohol/subs interv 15-30mn (G0396) | $42.60 | $71 | 1.0× |
| Alcohol/subs interv >30 min (G0397) | $208.80 | $348 | 1.0× |
| Catheterize for urine spec (P9612) range across 2 matching MRF lines |
$130.80–$207.60 | $218–$346 | varies |
| Chemo extend iv infus w/pump (G0498) | $751.20 | $1,252 | 1.9× |
| Covid-19 lab test non-cdc (U0002) range across 3 matching MRF lines |
$81–$87.60 | $135–$146 | varies |
| Diab manage trn per indiv (G0108) | $102.60 | $171 | 1.8× |
| Diab manage trn ind/group (G0109) | $58.20 | $97 | 3.6× |
| Direct refer hospital observ (G0379) | $76.20 | $127 | 0.1× |
| Drug test def 1-7 classes (G0480) range across 58 matching MRF lines |
$46.80–$338.40 | $78–$564 | varies |
| Drug test def 8-14 classes (G0481) range across 4 matching MRF lines |
$54–$267 | $90–$445 | varies |
| Ekg tracing for initial prev (G0404) | $30.60 | $51 | 0.9× |
| Hospital outpt clinic visit (G0463) range across 6 matching MRF lines |
$144.60–$259.20 | $241–$432 | varies |
| Hpv combo assay ca screen (G0476) range across 2 matching MRF lines |
$72.60–$75.60 | $121–$126 | varies |
| Inj for sacroiliac jt anesth (G0260) | $597.60 | $996 | 0.7× |
| Insj/Rplc Car Modulj Sys Pls Gen Transvns Eltrd (0408T) unusually low: confirm this is the full procedure |
$11,401.80 | $19,003 | 0.3× |
| Mra w/cont, abd (C8900) | $1,566 | $2,610 | 3.8× |
| Mra w/cont, chest (C8909) | $1,566 | $2,610 | 3.8× |
| Mra w/cont, lwr ext (C8912) | $1,566 | $2,610 | 3.8× |
| Mra w/cont, pelvis (C8918) | $1,566 | $2,610 | 3.8× |
| Mra w/o cont, abd (C8901) | $1,475.40 | $2,459 | 5.2× |
| Mra w/o cont, chest (C8910) | $1,498.80 | $2,498 | 5.3× |
| Mra w/o cont, lwr ext (C8913) | $1,475.40 | $2,459 | 5.2× |
| Mra w/o cont, pelvis (C8919) | $1,475.40 | $2,459 | 5.2× |
| Mra w/o fol w/cont, abd (C8902) | $1,702.80 | $2,838 | 4.1× |
| Mra w/o fol w/cont, chest (C8911) | $1,702.80 | $2,838 | 4.1× |
| Mra w/o fol w/cont, lwr ext (C8914) | $1,675.20 | $2,792 | 4.1× |
| Mra w/o fol w/cont, pelvis (C8920) | $1,675.20 | $2,792 | 4.1× |
| Mra, w/dye, spinal canal (C8931) | $1,566 | $2,610 | 3.8× |
| Mra, w/dye, upper extremity (C8934) | $1,323.60 | $2,206 | 3.2× |
| Mra, w/o dye, spinal canal (C8932) | $1,285.80 | $2,143 | 4.6× |
| Mra, w/o dye, upper extr (C8935) | $1,242 | $2,070 | 4.4× |
| Mra, w/o&w/dye, spinal canal (C8933) | $1,675.20 | $2,792 | 4.1× |
| Mra, w/o&w/dye, upper extr (C8936) | $1,422 | $2,370 | 3.5× |
| Mri w/o fol w/cont, breast, (C8908) | $2,461.20 | $4,102 | 6.0× |
| Mri w/o fol w/cont, brst, un (C8905) | $1,757.40 | $2,929 | 4.3× |
| Neuro csf prion prtn qual (0035U) | $789 | $1,315 | 1.5× |
| Pattern erg w/i&r (0509T) | $274.80 | $458 | 1.1× |
| Perc d-e cor revasc chro sin (C9607) | $25,782.60 | $42,971 | 1.2× |
| Perc d-e cor revasc t cabg s (C9604) | $26,205.60 | $43,676 | 1.9× |
| Perc d-e cor stent ather s (C9602) | $26,205.60 | $43,676 | 1.2× |
| Perc drug-el cor stent sing (C9600) | $17,005.80 | $28,343 | 1.2× |
| Perq Sacral Augmt Bilat Inj (0201T) unusually low: confirm this is the full procedure |
$2,610.60 | $4,351 | 0.3× |
| Perq Sacral Augmt Unilat Inj (0200T) unusually low: confirm this is the full procedure |
$2,610.60 | $4,351 | 0.3× |
| Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) | $7,908.60 | $13,181 | 0.6× |
| Prgrmg dev eval ldls pm single car chamber ip (0826T) | $55.80 | $93 | 1.3× |
| Prostate biopsy, any mthd (G0416) | $301.80 | $503 | 0.7× |
| Psa screening (G0103) | $66.60 | $111 | 3.4× |
| Scr c/v cyto,thinlayer,rescr (G0145) | $134.40 | $224 | 5.1× |
| Screen cerv/vag thin layer (G0123) range across 3 matching MRF lines |
$48–$76.20 | $80–$127 | varies |
| Screen pap by tech w md supv (P3000) range across 5 matching MRF lines |
$24.60–$34.20 | $41–$57 | varies |
| Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T) | $11,881.20 | $19,802 | 0.5× |
| Tcat Insj Perm Dual Chamber Ldls Pm Compl Sys (0795T) | $11,881.20 | $19,802 | 0.5× |
| Tcat rmvl perm 1chmbr ldls pacemaker r atrial (0824T) | $3,726 | $6,210 | 1.0× |
| Tcat rmvl&rplcmt perm 1chmbr ldls pm r atrial (0825T) | $11,881.20 | $19,802 | 0.5× |
| Tcat Rmvl/Debulk Icar Mass Suction Device Perq (0644T) | $4,573.20 | $7,622 | 0.7× |
| Therapeutic ultrafiltration (0692T) | $728.40 | $1,214 | 0.4× |
| Tomosynthesis, mammo (G0279) range across 2 matching MRF lines |
$30–$48 | $50–$80 | varies |
| Trluml Perip Athrc Iliac Art (0238T) unusually low: confirm this is the full procedure |
$9,766.80 | $16,278 | 0.5× |
| Tte w or w/o contr, cont ecg (C8930) range across 4 matching MRF lines |
$1,236.60–$1,465.20 | $2,061–$2,442 | varies |
| Tte w or w/o fol w/con,stres (C8928) range across 4 matching MRF lines |
$1,189.80–$1,432.80 | $1,983–$2,388 | varies |
| Tte w or w/o fol w/cont, com (C8921) | $1,294.20 | $2,157 | 1.4× |
| Tte w or w/o fol w/cont, f/u (C8922) range across 2 matching MRF lines |
$1,068–$1,170 | $1,780–$1,950 | varies |
| Tte w or wo fol wcon,doppler (C8929) range across 2 matching MRF lines |
$1,269.60–$1,330.20 | $2,116–$2,217 | varies |
| Unsched dialysis esrd pt hos (G0257) range across 3 matching MRF lines |
$459.60–$1,309.80 | $766–$2,183 | varies |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.