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.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Ablate Heart Dysrhythm Focus (93650) | $6,853.80 | $11,423 | 0.7× |
| Admn Sarscov2 Vacc 1 Dose (90480) | $45.60 | $76 | 0.9× |
| Airway Inhalation Treatment (94640) range across 11 matching MRF lines |
$78.60–$264 | $131–$440 | varies |
| Application on-body injector (96377) | $76.80 | $128 | 1.4× |
| Blink reflex test (95933) | $90 | $150 | 1.3× |
| Brncdilat rspse spmtry pre&post-brncdilat admn (94060) range across 2 matching MRF lines |
$62.40–$402 | $104–$670 | varies |
| 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 proc (95992) | $84.60 | $141 | 2.1× |
| Cardiac Stress Tst,Tracing Only (93017) range across 4 matching MRF lines |
$480–$487.80 | $800–$813 | varies |
| Cardiopulmonary resuscitation (92950) range across 2 matching MRF lines |
$502.20–$509.40 | $837–$849 | varies |
| Cardioversion (92960) range across 2 matching MRF lines |
$1,183.20–$1,200 | $1,972–$2,000 | varies |
| Caregiver Training Strategies&Tq Ea Addl 15 Min (97551) | $104.40 | $174 | 4.0× |
| Cath Place/Coron Angio, Img Super/Interp,R&L Hrt Cath, L Hrt Ventric (93460) | $8,539.80 | $14,233 | 2.2× |
| Cath Place/Coron Angio, Img Super/Interp,W Left Heart Ventriculography (93458) | $6,432 | $10,720 | 1.7× |
| Cbt 1st hour (94644) range across 2 matching MRF lines |
$136.80–$253.80 | $228–$423 | varies |
| Chemo Anti-Neopl Sq/Im (96401) | $237.60 | $396 | 2.8× |
| Chemo Hormon Antineopl Sq/Im (96402) | $176.40 | $294 | 2.1× |
| Chemo Ia Push (96420) | $708 | $1,180 | 1.8× |
| Chemo IV infusion addl hr (96415) | $276.60 | $461 | 3.3× |
| Chemo IV push addl drug (96411) | $291.60 | $486 | 3.4× |
| Chemother Prolong Infuse W/Pump (96416) | $751.20 | $1,252 | 1.9× |
| Chemotherapy Into Cns (96450) range across 2 matching MRF lines |
$481.20–$518.40 | $802–$864 | varies |
| Chemotherapy Unspecified (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 nfs tq up 1 hr 1/1st sbst/drug (96413) | $708 | $1,180 | 1.8× |
| Chemotx admn IV push tq 1/1st sbst/drug (96409) | $446.40 | $744 | 1.1× |
| Chest Wall Manipulation (94668) | $126 | $210 | 0.8× |
| Chron Care Mgmt Srvc 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× |
| Community/Work Reintegration Trainj Ea 15 Min (97537) | $82.80 | $138 | 2.6× |
| Continuous Pulse Ox (94762) | $309 | $515 | 2.0× |
| 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 Ventilation Cpap Initiation&Mgmt (94660) range across 7 matching MRF lines |
$60–$1,135.80 | $100–$1,893 | varies |
| Cpt initial (94667) | $164.40 | $274 | 1.0× |
| Cptrizd oph dx img pst sgm uni/bi rta oct angrph (92137) | $37.80 | $63 | 0.1× |
| Critical care first hour (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) range across 2 matching MRF lines |
$310.20–$560.40 | $517–$934 | varies |
| Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) | $513.60 | $856 | 4.2× |
| Dup-Scan Xtr Veins Complete Bilateral Study (93970) | $595.80 | $993 | 2.1× |
| Dup-scan xtr veins unilateral/limited study (93971) range across 2 matching MRF lines |
$268.80–$501.60 | $448–$836 | varies |
| Duplex Scan Hemodialysis Access (93990) | $274.80 | $458 | 2.2× |
| Duplex up extrem art bilat (93930) | $516 | $860 | 1.8× |
| Duplex up extrem art unilat/ltd (93931) | $373.80 | $623 | 3.0× |
| Echo Congenital Complete (93303) range across 3 matching MRF lines |
$1,107–$1,294.20 | $1,845–$2,157 | varies |
| Echo Heart Xthoracic,Limited (93308) range across 4 matching MRF lines |
$495–$805.20 | $825–$1,342 | varies |
| Echo transesophageal (93312) range across 3 matching MRF lines |
$1,164–$1,356 | $1,940–$2,260 | varies |
| Echo Transesophageal - Congenital Tee Complete (93315) | $1,105.80 | $1,843 | 1.7× |
| Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351) range across 3 matching MRF lines |
$1,159.80–$1,257.60 | $1,933–$2,096 | varies |
| Eeg 41-60 Minutes (95812) | $456.60 | $761 | 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 cont rec w/video by tech min 8 channels (95700) | $519 | $865 | 2.0× |
| EEG extended monitoring 61-119 minutes (95813) | $580.80 | $968 | 2.3× |
| Eeg Sleep Only (95822) | $621.60 | $1,036 | 2.4× |
| 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× |
| Electro-Oculography (92270) | $159 | $265 | 1.0× |
| Electrocardiogram Tracing (93005) range across 3 matching MRF lines |
$16.80–$243 | $28–$405 | varies |
| Electrophysiologic Follow-Up W/Pac/Rec W/Arrhyt (93624) | $7,070.40 | $11,784 | 0.8× |
| Electrophysiology Evaluation (93642) | $1,525.20 | $2,542 | 1.1× |
| Emergency Dept Visit Level 2 (99282) | $474.60 | $791 | 2.6× |
| Emergency Dept Visit Level 3 (99283) | $1,029 | $1,715 | 3.2× |
| Emergency Dept Visit Level 4 (99284) | $1,576.80 | $2,628 | 3.2× |
| Emg 3 Extremities (95863) | $294 | $490 | 1.9× |
| Emg 4 Extremities (95864) | $353.40 | $589 | 2.3× |
| 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 Esophageal Recording Atria+Pacing (93616) | $1,074.60 | $1,791 | 0.7× |
| Er level 1 (99281) | $286.20 | $477 | 2.9× |
| Er level v (99285) | $2,260.80 | $3,768 | 3.2× |
| Evaluate pt use of inhaler (94664) | $103.80 | $173 | 0.4× |
| Evaluate Speech Production (92522) | $213.60 | $356 | 1.9× |
| Evaluate Swallowing Function (92610) range across 2 matching MRF lines |
$95.40–$281.40 | $159–$469 | varies |
| 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× |
| Extracranial Bilat Study (93880) | $674.40 | $1,124 | 2.4× |
| Extracranial Uni/Ltd Study (93882) | $620.40 | $1,034 | 5.0× |
| F-up/limited tthrc echo congenital car anomaly (93304) range across 3 matching MRF lines |
$966–$1,170 | $1,610–$1,950 | varies |
| 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× |
| Heart catheterization, both sides, with coronary and bypass graft angiography (93461) | $10,082.40 | $16,804 | 2.6× |
| Holter monitor recording (93225) | $286.20 | $477 | 1.8× |
| Immunization administration (90471) range across 3 matching MRF lines |
$67.20–$72.60 | $112–$121 | varies |
| Indocyanine-green angrph w/multiframe i&r uni/bi (92240) | $571.80 | $953 | 2.2× |
| Insert/Place Heart Catheter (93503) | $1,141.80 | $1,903 | 0.6× |
| Interrogate Subq Defib (93261) | $83.40 | $139 | 1.9× |
| Intra-atrial pacing (93610) likely a partial charge, not the full procedure |
$2,562 | $4,270 | 0.3× |
| Intra-atrial recording (93602) likely a partial charge, not the full procedure |
$2,562 | $4,270 | 0.3× |
| Intracranial Complete Study (93886) | $517.80 | $863 | 1.8× |
| 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 therapy prophylaxis/dx ea hour (96366) range across 2 matching MRF lines |
$187.20–$245.40 | $312–$409 | varies |
| IV push initial (96374) | $216.60 | $361 | 0.9× |
| L Hrt Art/Grft Angio (93459) | $7,392.60 | $12,321 | 1.9× |
| Lung Function Test (Mbc/Mvv) (94200) | $161.40 | $269 | 2.3× |
| Lwr Xtr Vasc Stdy Bilat (93924) | $523.80 | $873 | 2.1× |
| 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 Fluoroscopy/Swallow (92611) | $214.20 | $357 | 2.3× |
| Multifocal Electroretinography W/I&R (92274) | $274.80 | $458 | 1.8× |
| Muscle Test 2 Limbs (95861) | $183.60 | $306 | 1.2× |
| Muscle Test Hemidiaphragm (95866) | $171 | $285 | 1.1× |
| Muscle Test Nonparaspinal (95870) | $90 | $150 | 0.6× |
| Muscle Test One Limb (95860) | $156 | $260 | 1.0× |
| 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 larynx (95865) range across 2 matching MRF lines |
$114–$171 | $190–$285 | varies |
| Needle Emg Thrc Paraspi Musc Excluding T1/T12 (95869) | $90 | $150 | 0.4× |
| Nerve Conduction Studies 1-2 Studies (95907) | $275.40 | $459 | 1.1× |
| Nerve Conduction Studies 11-12 Studies (95912) | $961.80 | $1,603 | 2.2× |
| Nerve conduction studies 13 or more 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× |
| Neuromuscular Junct Tstg Ea Nrv Any 1 Meth (95937) | $228 | $380 | 1.5× |
| Neuromuscular Reeducation (97112) | $107.40 | $179 | 3.3× |
| Oculoelectromyography (92265) | $88.80 | $148 | 1.3× |
| Oral Function Therapy (92526) | $214.80 | $358 | 2.6× |
| Oral Speech Device Eval (92597) range across 2 matching MRF lines |
$102.60–$168.60 | $171–$281 | varies |
| Orthc/Prostc Mgmt Sbsq Enc (97763) | $99 | $165 | 2.0× |
| Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) | $91.20 | $152 | 2.0× |
| Ot eval high complexity (97167) | $249 | $415 | 2.5× |
| Ot Eval Low Complex (97165) | $201.60 | $336 | 2.0× |
| Ot Eval Moderate Complexity (97166) | $220.20 | $367 | 2.2× |
| Ot manual therapy 15 min (97140) range across 2 matching MRF lines |
$108.60–$129 | $181–$215 | varies |
| Ot Prosthetic Training, Each 15 Min (97761) | $92.40 | $154 | 2.3× |
| Ot Re-Eval Est Plan Care (97168) | $145.20 | $242 | 2.1× |
| Perq Tcat Plmt Ntrac St 2+Les 2+St 2+C Segments (92930) likely a partial charge, not the full procedure |
$4,251.60 | $7,086 | 0.2× |
| 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× |
| Physical Performance Test (97750) | $82.80 | $138 | 2.5× |
| Plethysmography (94726) range across 2 matching MRF lines |
$74.40–$325.20 | $124–$542 | varies |
| Prgrmg Dev Eval Implantable Subq Lead Dfb System (93260) | $83.40 | $139 | 1.9× |
| Prq Card Angio/Athrect 1 Art (92924) | $9,051.60 | $15,086 | 0.7× |
| Prq Card Stent W/Angio 1 Vsl (92928) range across 2 matching MRF lines |
$16,731.60–$17,005.80 | $27,886–$28,343 | varies |
| Prq Card Stent/Ath/Angio (92933) range across 2 matching MRF lines |
$25,782.60–$26,205.60 | $42,971–$43,676 | varies |
| Prq Revasc Byp Graft 1 Vsl (92937) range across 2 matching MRF lines |
$25,782.60–$26,205.60 | $42,971–$43,676 | varies |
| Prq trl rvs ch occ ant&rtrgr (92945) | $16,777.20 | $27,962 | 1.2× |
| Pt Eval High Complex (97163) | $289.20 | $482 | 3.0× |
| Pt eval low complex 20 min (97161) | $211.20 | $352 | 2.2× |
| Pt Eval Mod Complex (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 Re-Eval Est Plan Care (97164) | $143.40 | $239 | 2.1× |
| Pulmonary service/procedure (94799) range across 4 matching MRF lines |
$40.20–$198.60 | $67–$331 | varies |
| Pulmonary Stress Testing (94618) range across 2 matching MRF lines |
$44.40–$279 | $74–$465 | varies |
| 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 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× |
| R&L Hrt Cath W/Ventriclgrphy (93453) | $6,061.80 | $10,103 | 1.6× |
| Refill/Maint Portable Pump (96521) | $319.20 | $532 | 1.3× |
| Respiratory flow volume loop (94375) | $277.80 | $463 | 1.1× |
| Rhythm Ecg 1-3 Leads Tracing Only W/O I&R (93041) | $165 | $275 | 2.4× |
| Right Heart Cath (93451) | $4,450.20 | $7,417 | 1.2× |
| Right ventricular recording (93603) | $1,420.20 | $2,367 | 1.0× |
| Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) | $253.80 | $423 | 2.1× |
| 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× |
| Self Care Mngment Training (97535) | $87.60 | $146 | 2.7× |
| 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× |
| Somatosensory Testing (95938) | $528 | $880 | 0.5× |
| Speech sound lang comprehen (92523) | $256.80 | $428 | 1.1× |
| Spirometry (94010) range across 3 matching MRF lines |
$83.40–$264.60 | $139–$441 | varies |
| Ssep lower limbs (95926) range across 2 matching MRF lines |
$450.60–$664.20 | $751–$1,107 | varies |
| Standardized Cognitive Performance Testing (96125) | $263.40 | $439 | 2.6× |
| Stress Tte Only (93350) range across 2 matching MRF lines |
$1,113–$1,225.20 | $1,855–$2,042 | varies |
| 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 Ea Addl 15 Min (97130) | $48.60 | $81 | 2.3× |
| Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) range across 2 matching MRF lines |
$115.20–$346.20 | $192–$577 | varies |
| Ther/Proph/Diag Inj Sc/Im (96372) | $101.40 | $169 | 1.2× |
| Ther/Proph/Diag Iv Inf Init (96365) | $413.40 | $689 | 1.6× |
| Therapeutic Activities (97530) | $104.40 | $174 | 3.0× |
| Tilt table test with heart rhythm and blood pressure monitoring (93660) | $1,023 | $1,705 | 2.3× |
| Tobacco Use Cessation Intensive >10 Minutes (99407) | $68.40 | $114 | 1.5× |
| Tobacco Use Cessation Intermediate 3-10 Minutes (99406) | $63.60 | $106 | 1.4× |
| Transcath Closure of Asd (93580) | $11,974.20 | $19,957 | 0.6× |
| Transcranial Doppler Stdy Intracranial Art Lmtd (93888) | $274.80 | $458 | 2.2× |
| Tte w/doppler, complete (93306) range across 3 matching MRF lines |
$1,209–$1,330.20 | $2,015–$2,217 | varies |
| 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/Pro/Dx Inj New Drug Addon (96375) | $100.20 | $167 | 1.8× |
| Unlis neurological/neuromuscular dx px (95999) | $81 | $135 | 0.5× |
| Unlisted cardiovascular service/procedure (93799) range across 4 matching MRF lines |
$248.40–$1,329 | $414–$2,215 | varies |
| Upr/L Xtremity Art 2 Levels (93922) range across 2 matching MRF lines |
$178.20–$292.80 | $297–$488 | varies |
| Upr/Lxtr Art Stdy 3+ Lvls (93923) | $322.20 | $537 | 1.3× |
| Veeg 2-12 Hr Cont Mntr (95713) | $1,132.20 | $1,887 | 2.6× |
| Veeg 2-12 hr intmt mntr (95712) | $604.20 | $1,007 | 1.4× |
| Veeg 2-12 hr unmonitored (95711) | $604.20 | $1,007 | 2.4× |
| 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× |
| Veeg ea 12-26hr cont mntr (95716) | $2,170.80 | $3,618 | 2.1× |
| Vent Mgmt Inpat Init Day (94002) range across 2 matching MRF lines |
$1,237.80–$1,530.60 | $2,063–$2,551 | varies |
| Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) range across 2 matching MRF lines |
$1,066.80–$1,452.60 | $1,778–$2,421 | varies |
| 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× |
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.