Visits & medical services prices at Pali Momi Medical Center

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

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

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ProcedureCash priceGross charge× Medicare
Ablation av node (93650) $6,853.80 $11,423 0.7×
Airway inhalation treatment (94640) $201.60 $336 0.8×
Application on-body injector (96377) $76.80 $128 1.4×
Bedside Swallowing Eval (92610) $188.40 $314 2.2×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060) $232.20 $387 0.5×
Bundle of his recording (93600)
likely a partial charge, not the full procedure
$2,091.60 $3,486 0.2×
C motor evoked upr&lwr limbs (95939) $1,813.20 $3,022 1.8×
Canalith Repositioning Procedure (95992) $84.60 $141 2.1×
Cardiac Stress Tst,Tracing Only (93017) $487.80 $813 1.9×
Cardiopulmonary resuscitation (92950) $505.80 $843 2.0×
Cardioversion (92960) $1,191.60 $1,986 1.5×
Caregiver Training Strategies&Tq Ea Addl 15 Min (97551) $104.40 $174 4.0×
Cath Perc Clos,Cong Interatrial Commun W/Impl (93580) $11,974.20 $19,957 0.6×
Cath Place/Coron Angio, Img Super/Interp,W Left Heart Ventriculography (93458) $6,432 $10,720 1.7×
Cbt 1st hour (94644) $195.30 $325.50 1.2×
Chemo Hormon Antineopl Sq/Im (96402) $176.40 $294 2.1×
Chemo IV push addl drug (96411) $291.60 $486 3.4×
Chemo prolong 8+ hrs infuse w/pump (96416) $751.20 $1,252 1.9×
Chemother, IV infusion, 1 hr (96413) $708 $1,180 1.8×
Chemother, IV infusion, ea add hr (96415) $276.60 $461 3.3×
Chemother,Ia Push Technique (96420) $708 $1,180 1.8×
Chemother,Non-Hormone Anti-Neopl, Sub-Q/Im (96401) $237.60 $396 2.8×
Chemotherapy into cns (96450) $499.80 $833 1.3×
Chemotherapy, unspecified procedure (96549) $241.80 $403 4.4×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $165.60 $276 1.9×
Chemotx admn IV push tq 1/1st sbst/drug (96409) $446.40 $744 1.1×
Chronic care management services 1st 20 min (99490) $45 $75 0.4×
Color/duplex Doppler, complete (93975) $794.40 $1,324 2.8×
Color/duplex Doppler, limited (93976) $667.20 $1,112 5.4×
Coronary art/grft angio s&i (93455) $8,620.20 $14,367 2.3×
Coronary artery angio s&i (93454) $7,693.80 $12,823 2.0×
Cpap/bipap (94660) $305.40 $509 1.2×
Cpt initial (94667) $164.40 $274 1.0×
Cptrz oph img pst sg rta oct (92137) $37.80 $63 0.1×
Critical care (99291) $3,713.40 $6,189 3.8×
Debridement Open Wound 20 Sq Cm< (97597) $336 $560 1.4×
Dup-Scan Aorta Ivc Iliac Vascl/Bpgs Complete (93978) $710.40 $1,184 2.5×
Dup-scan artl infl&ven o/f pen vsl compl (93980) $248.40 $414 2.0×
Dup-Scan Lxtr Art/Artl Bpgs Compl Bi Study (93925) $435.30 $725.50 1.5×
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) $513.60 $856 4.2×
Dup-Scan Uxtr Art/Artl Bpgs Compl Bi Study (93930) $516 $860 1.8×
Dup-Scan Uxtr Art/Artl Bpgs Uni/Lmtd Study (93931) $373.80 $623 3.0×
Dup-Scan Xtr Veins Complete Bilateral Study (93970) $595.80 $993 2.1×
Dup-scan xtr veins unilateral/limited study (93971) $385.20 $642 3.1×
Duplex scan extracranial art compl bi study (93880) $674.40 $1,124 2.4×
Duplex Scan Hemodialysis Access (93990) $274.80 $458 2.2×
Echo Heart Xthoracic,Limited (93308) $621 $1,035 2.2×
Echo transesophageal (93312) $1,242.60 $2,071 1.9×
Echo Transesophageal - Congenital Tee Complete (93315) $1,105.80 $1,843 1.7×
Echo Transthoracic - Congenital Tte Complete (93303) $1,294.20 $2,157 2.0×
Echo Transthoracic - Congenital Tte Limited (93304) $1,068 $1,780 1.7×
Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351) $1,171.80 $1,953 1.8×
EEG awake and asleep (95819) $595.20 $992 2.3×
EEG awake drowsy (95816) $510 $850 2.0×
EEG cerebral death evaluation (95824) $217.80 $363 0.5×
EEG coma or sleep only (95822) $621.60 $1,036 2.4×
EEG cont rec w/video by tech min 8 channels (95700) $519 $865 2.0×
EEG greater than 1 hour (95813) $580.80 $968 2.3×
Eeg W/O Vid 2-12 Hr Unmntr (95705) $509.40 $849 2.0×
EEG w/o vid tech ea incr 12-26 hr cont r-t mntr (95710) $868.20 $1,447 2.0×
EKG rhythm strip (93041) $165 $275 2.4×
Electro-oculography with interpretation and report Non-Facility (92270) $159 $265 1.0×
Electrocardiogram Tracing (93005) $238.80 $398 3.4×
Electroencephalogram Extend Monitoring 41-60 Min (95812) $456.60 $761 1.8×
Electrophysiologic Follow-Up W/Pac/Rec W/Arrhyt (93624) $7,070.40 $11,784 0.8×
EMG four extremities (95864) $353.40 $589 2.3×
EMG one extremity (95860) $156 $260 1.0×
EMG three extremities (95863) $294 $490 1.9×
EMG two extremities (95861) $183.60 $306 1.2×
Endomyocardial biopsy (93505) $3,943.80 $6,573 1.1×
Ep & ablate supravent arrhyt (93653)
unusually low: confirm this is the full procedure
$14,996.40 $24,994 0.5×
Ep & ablate ventric tachy (93654) $25,821.60 $43,036 0.8×
Ep Compre Electrophysiologic Arrhythmia Induction (93620) $5,666.40 $9,444 0.6×
Ep Compre Electrophysiologic W/O Arrhyt Induction (93619) $7,388.40 $12,314 0.8×
Ep Ephys Eval Pacg Cvdfb Prgrmg/Reprgrmg Parameters (93642) $1,525.20 $2,542 1.1×
Ep Esophageal Recording Atria+Pacing (93616) $1,074.60 $1,791 0.7×
Er level 1 (99281) $286.20 $477 2.9×
Er level ii (99282) $474.60 $791 2.6×
Er level iii (99283) $1,029 $1,715 3.2×
Er level IV (99284) $1,576.80 $2,628 3.2×
Er level v (99285) $2,260.80 $3,768 3.2×
Eval speech sound production (92522) $213.60 $356 1.9×
Eval to use/fit voice prosth (92597) $135.60 $226 1.9×
Evaluate Pt Use Of Inhaler (94664) $103.80 $173 0.4×
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with… (92607) $253.80 $423 2.1×
Evaluation of speech fluency (92521) $247.20 $412 1.9×
External ECG rec>48hr<7d recording (93242) $57.60 $96 1.3×
External ECG rec>7d<15d recording (93246) $105.60 $176 2.4×
External Ecg Scanning Analysis Report (93226) $477.60 $796 6.9×
Flexible Endoscopic Eval Swallow C/V Rec (92612) $502.80 $838 2.5×
Full field electroretinography w/i&r (92273) $507.60 $846 2.0×
Holter Monitor (93225) $286.20 $477 1.8×
Imm admn sarscov2 vaccine single dose (90480) $45.60 $76 0.9×
Immunization Admin (90471) $72.60 $121 0.9×
Indocyanine-Green Angrph W/Multiframe I&R Uni/Bi (92240) $571.80 $953 2.2×
Ins swan ganz bedside (93503) $1,141.80 $1,903 0.6×
Interrogate subq defib (93261) $83.40 $139 1.9×
Intra Atrial Recording (93602)
likely a partial charge, not the full procedure
$2,562 $4,270 0.3×
Intra-atrial pacing (93610)
likely a partial charge, not the full procedure
$2,562 $4,270 0.3×
Intraventricular pacing (93612)
likely a partial charge, not the full procedure
$2,091.60 $3,486 0.2×
Irrig drug delivery device (96523) $106.20 $177 1.5×
IV infusion hydration each additional hour (96361) $186 $310 3.4×
IV infusion hydration initial 31 min-1 hour (96360) $418.20 $697 1.7×
IV infusion ther proph addl sequential to 1 hr (96367) $185.40 $309 2.2×
IV infusion, therap/proph/diagnost,initial,1st hour (96365) $413.40 $689 1.6×
IV infusion, therap/proph/diagnost,initial,ea add hour (96366) $216.30 $360.50 3.9×
IV push ea addl new drug (96375) $100.20 $167 1.8×
IV push initial (96374) $216.60 $361 0.9×
L hrt art/grft angio (93459) $7,392.60 $12,321 1.9×
Manual therapy 15 min (97140) $118.80 $198 4.3×
Maximum voluntary ventilation (94200) $161.40 $269 2.3×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $34.80 $58 1.1×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $42 $70 1.1×
Motion Fluor Eval Swlng Funcj C/V Rec (92611) $214.20 $357 2.3×
Multifocal electroretinography w/i&r (92274) $274.80 $458 1.8×
Needle Electromyography Cranial Nrv Muscle Bi (95868) $521.40 $869 2.0×
Needle Electromyography Cranial Nrv Muscle Uni (95867) $521.40 $869 2.0×
Needle electromyography hemidiaphragm (95866) $171 $285 1.1×
Needle electromyography larynx (95865) $142.50 $237.50 0.9×
Needle EMG lmtd std musc 1 xtr/non-limb uni/bi (95870) $90 $150 0.6×
Needle Emg Thrc Paraspi Musc Excluding T1/T12 (95869) $90 $150 0.4×
Needle oculoelectromyography, 1 or more extraocular muscles, 1 or both eyes, with interpretation and report Non-Facility (92265) $88.80 $148 1.3×
Nerve Conduction Studies 11-12 Studies (95912) $961.80 $1,603 2.2×
Nerve conduction studies 13/> studies (95913) $961.80 $1,603 2.2×
Nerve Conduction Studies 3-4 Studies (95908) $521.40 $869 2.0×
Nerve Conduction Studies 5-6 Studies (95909) $521.40 $869 2.0×
Nerve Conduction Studies 7-8 Studies (95910) $521.40 $869 1.2×
Nerve Conduction Studies 9-10 Studies (95911) $961.80 $1,603 2.2×
Nerve conduction studies; 1-2 studies (95907) $275.40 $459 1.1×
Neuromuscular Junct Tstg Ea Nrv Any 1 Meth (95937) $228 $380 1.5×
Non-Invas Physiologic Std Extremity Art 2 Level (93922) $235.50 $392.50 1.5×
Noninvasive Ear/Pulse Oximetry Overnight Monitor (94762) $309 $515 2.0×
Orbicularis Oculi Reflx Electrodiagnostic Test (95933) $90 $150 1.3×
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) $91.20 $152 2.0×
Ot Community/Work Reintegration Trainj Ea 15 Min (97537) $82.80 $138 2.6×
Ot eval high complex 60 min (97167) $249 $415 2.5×
Ot eval low complex 30 min (97165) $201.60 $336 2.0×
Ot eval mod complex 45 min (97166) $220.20 $367 2.2×
Ot Orthotics/Prosth Mgmt &/Trainj Sbsq Enctr 15 Min (97763) $99 $165 2.0×
Ot Prosthetic Training, Each 15 Min (97761) $92.40 $154 2.3×
Ot re-evaluation (97168) $145.20 $242 2.1×
Ot therapeutic activity 15 min (97530) $104.40 $174 3.0×
Perq Trluml C Angioplasty 1 Maj C Art&/Branches (92920) $7,717.20 $12,862 1.1×
Perq Trluml Revsc Chrnc Tot Occls 1 C Art Antgrd (92943) $25,782.60 $42,971 1.9×
Phlebotomy therapeutic (99195) $262.20 $437 1.7×
Plethysmography (94726) $199.80 $333 0.5×
Prgrmg Dev Eval Implantable Subq Lead Dfb System (93260) $83.40 $139 1.9×
Prq Card Stent W/Angio 1 Vsl (92928) $16,868.70 $28,114.50 1.2×
Prq Card Stent/Ath/Angio (92933) $25,994.10 $43,323.50 1.2×
Prq Revasc Byp Graft 1 Vsl (92937) $25,994.10 $43,323.50 1.9×
Prq tcat plmt ntrac st 2+les (92930)
likely a partial charge, not the full procedure
$4,251.60 $7,086 0.2×
Prq trl rvs ch occ ant&rtrgr (92945) $16,777.20 $27,962 1.2×
Prq trluml coronary angio/atherect one art/brnch (92924) $9,051.60 $15,086 0.7×
Pt eval high complex 45 min (97163) $289.20 $482 3.0×
Pt eval low complex 20 min (97161) $211.20 $352 2.2×
Pt eval mod complex 30 min (97162) $218.40 $364 2.2×
Pt gait training 15 min (97116) $82.20 $137 2.8×
Pt group caregiver training (97552) $67.80 $113 3.1×
Pt Neuromusc Reeducat,1+ Areas, Ea 15 Min (97112) $107.40 $179 3.3×
Pt Physical Performance Test (97750) $82.80 $138 2.5×
Pt re-evaluation (97164) $143.40 $239 2.1×
Pt Self-Care/Home Mgmt Training Each 15 Minutes (97535) $87.60 $146 2.7×
Pulmonary Service/Procedure (94799) $154.20 $257 1.0×
Pulmonary stress test simple (94618) $161.70 $269.50 1.0×
R & l hrt cath w/njx l ventriculog img s&i (93453) $6,061.80 $10,103 1.6×
R hrt art/grft angio (93457) $9,519 $15,865 2.5×
R Hrt Cath Chd W/Img Cath Trgt Zon Abnl Nt Connj (93594) $3,116.40 $5,194 0.8×
R Hrt Cath Chd W/Img Cath Trgt Zone Nml Nt Connj (93593) $3,116.40 $5,194 0.8×
R hrt coronary artery angio (93456) $9,388.80 $15,648 2.5×
R& L Hrt Cath W/Injec Hrt Art/Grft& L Vent I (93461) $10,082.40 $16,804 2.6×
R&l hrt art/ventricle angio (93460) $8,539.80 $14,233 2.2×
R&L Hrt Cath Chd Img Cath Trgt Zon Abnl Nt Connj (93597) $3,116.40 $5,194 0.8×
R&L Hrt Cath Chd Img Cath Trgt Zone Nml Nt Connj (93596) $3,445.80 $5,743 0.9×
Refill/Maint Portable Pump (96521) $319.20 $532 1.3×
Respiratory flow volume loop (94375) $277.80 $463 1.1×
Right heart cath (93451) $4,450.20 $7,417 1.2×
Right ventricular recording (93603) $1,420.20 $2,367 1.0×
Rt Chest Wall Manipulation,Subsequent (94668) $126 $210 0.8×
Rx Sp-Genratj Augmnt&Comunicaj Dev Ea 30 Min (92608) $93.60 $156 2.0×
Rx/Physical Eeg Activaj Phys/Qhp Attendance (95954) $961.80 $1,603 2.2×
Short-latency somatosens ep std upr limbs (95925) $578.40 $964 2.3×
Slp caregiver training 1st 30 min (97550) $137.40 $229 2.6×
Smoking cessation > 10 min (99407) $68.40 $114 1.5×
Somatosensory testing (95938) $528 $880 0.5×
Speech sound lang comprehen (92523) $256.80 $428 1.1×
Spirometry (94010) $258.60 $431 1.0×
Ssep lower limbs (95926) $557.40 $929 2.2×
Standardized Cognitive Performance Testing (96125) $263.40 $439 2.6×
Stress echo (93350) $1,169.10 $1,948.50 1.8×
Temp transcutaneous pacing (92953) $869.40 $1,449 1.1×
Tensilon test (95857) $409.80 $683 1.6×
Ther ivntj cog funcj cntct 1st 15 minutes (97129) $48.60 $81 2.2×
Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes (97130) $48.60 $81 2.3×
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) $230.70 $384.50 2.2×
Therapeutic prophylactic/dx injection subq/im (96372) $101.40 $169 1.2×
Tilt table evaluation (93660) $1,023 $1,705 2.3×
Tobacco Use Cessation Intermediate 3-10 Minutes (99406) $63.60 $106 1.4×
Transcran Doppler Intracran Art - Transcranial Doppler (93886) $517.80 $863 1.8×
Transcranial Doppler Stdy Intracranial Art Lmtd (93888) $274.80 $458 2.2×
Tte w/doppler, complete (93306) $1,269.60 $2,116 2.0×
Tx atrial fib pulm vein isol (93656) $21,110.40 $35,184 0.7×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) $155.40 $259 2.0×
Tx Swallowing Dysfunction&/Oral Funcj Feeding (92526) $214.80 $358 2.6×
Unlis neurological/neuromuscular dx px (95999) $81 $135 0.5×
Unlisted Cardiovascular Service/Procedure (93799) $754.80 $1,258 5.0×
Upr/lxtr art stdy 3+ lvls (93923) $322.20 $537 1.3×
Vasc Duplex Scan Extracranial,Limited (93882) $620.40 $1,034 5.0×
Vasc Non-Invasive Lower Extrem Art Stress/Rest, Complete,Bilateral (93924) $523.80 $873 2.1×
Veeg 2-12 hr unmonitored (95711) $604.20 $1,007 2.4×
Veeg by tech 2-12 hr continuous r-t monitoring (95713) $1,132.20 $1,887 2.6×
Veeg by tech 2-12 hr intermittent monitoring (95712) $604.20 $1,007 1.4×
Veeg by tech ea incr 12-26 hr cont r-t mntr (95716) $2,170.80 $3,618 2.1×
Veeg by tech ea incr 12-26 hr intermittent mntr (95715) $1,132.20 $1,887 2.6×
Veeg Ea 12-26 Hr Unmntr (95714) $1,159.20 $1,932 2.6×
Vent mgmt inpat init day (94002) $1,384.20 $2,307 1.9×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $1,259.70 $2,099.50 1.7×
Visual Evoked Potential Test (95930) $664.20 $1,107 2.6×
Vital capacity, total (94150) $200.40 $334 1.3×
Wheelchair Mgmt Ea 15 Min (97542) $91.80 $153 3.0×