Pali Momi Medical Center

98-1079 Moanalua Road, Aiea, HI 96701 · (808) 486-6000

Acute Care HospitalsProprietaryCMS rating 4/5Urban Honolulu, HI metro Website ↗

Price file

Prices published

File dated 2026-02-12

4,163 price rows for 68 procedures

Published prices

cash · negotiated range · list

Basic metabolic panel (blood test)

CPT 80048 · lowest of 2 lines · metro median $56

$56

cash

$8 to $80

112 negotiated rates

$94

list

CT scan of the abdomen and pelvis, with contrast

CPT 74177 · lowest of 6 lines · metro median $1,965

$1,965

cash

$181 to $3,384

84 negotiated rates

$3,275

list

CT scan of the head, no contrast

CPT 70450 · lowest of 2 lines · metro median $1,186

$1,059

cash

$74 to $1,500

30 negotiated rates

$1,765

list

CT scan of the pelvis, with contrast

CPT 72193 · lowest of 2 lines · metro median $1,292

$1,292

cash

$162 to $1,830

30 negotiated rates

$2,153

list

Cataract surgery with lens implant

CPT 66984

—

cash

$664 to $11,925

24 negotiated rates

—

list

Cesarean delivery with prenatal and postpartum care

CPT 59510

—

cash

$1,500 to $2,816

5 negotiated rates

—

list

Cesarean section hospital stay, no complications

MS-DRG 788

—

cash

$1,700 to $24,609

14 negotiated rates

—

list

Chlamydia test (DNA)

CPT 87491 · lowest of 22 lines · metro median $63

$63

cash

$34 to $258

448 negotiated rates

$105

list

Colonoscopy (diagnostic)

CPT 45378

—

cash

$470 to $5,681

24 negotiated rates

—

list

Colonoscopy with biopsy

CPT 45380

—

cash

$470 to $5,681

24 negotiated rates

—

list

Colonoscopy with polyp removal

CPT 45385

—

cash

$470 to $5,681

24 negotiated rates

—

list

Complete blood count (CBC) with differential

CPT 85025 · lowest of 6 lines · metro median $43

$43

cash

$8 to $63

112 negotiated rates

$71

list

Comprehensive metabolic panel (blood test)

CPT 80053 · lowest of 2 lines · metro median $68

$68

cash

$10 to $97

56 negotiated rates

$114

list

Diagnostic mammogram (both breasts)

CPT 77066 · lowest of 3 lines · metro median $417

$417

cash

$78 to $591

28 negotiated rates

$695

list

Electrocardiogram (ECG) with interpretation

CPT 93000

—

cash

$16 to $42

6 negotiated rates

—

list

Established patient office visit (about 40 minutes)

CPT 99215 · lowest of 2 lines · metro median $130

$130

cash

$84 to $173

7 negotiated rates

$216

list

Family psychotherapy with the patient

CPT 90847

—

cash

$83 to $210

14 negotiated rates

—

list

Family psychotherapy without the patient

CPT 90846

—

cash

$72 to $210

14 negotiated rates

—

list

Gallbladder removal (laparoscopic)

CPT 47562

—

cash

$678 to $11,721

19 negotiated rates

—

list

Gonorrhea test (DNA)

CPT 87591 · lowest of 23 lines · metro median $63

$63

cash

$34 to $258

449 negotiated rates

$105

list

Group psychotherapy

CPT 90853

—

cash

$25 to $121

14 negotiated rates

—

list

Hip or knee replacement, no major complications

MS-DRG 470

—

cash

$1,740 to $48,783

14 negotiated rates

—

list

Hospital stay for digestive disorders, no complications

MS-DRG 392

—

cash

$1,230 to $20,144

15 negotiated rates

—

list

Hysterectomy for non-cancer reasons, no complications

MS-DRG 743

—

cash

$1,740 to $31,634

14 negotiated rates

—

list

Inguinal hernia repair (age 5 and up)

CPT 49505

—

cash

$664 to $8,072

24 negotiated rates

—

list

Knee arthroscopy with meniscus repair

CPT 29881

—

cash

$664 to $8,072

24 negotiated rates

—

list

Laser treatment after cataract surgery (YAG)

CPT 66821

—

cash

$538 to $715

9 negotiated rates

—

list

Left heart catheterization

CPT 93452 · lowest of 2 lines · metro median $4,191

$4,191

cash

$664 to $11,429

30 negotiated rates

$6,985

list

Lipid panel (cholesterol test)

CPT 80061 · lowest of 6 lines · metro median $28

$28

cash

$13 to $135

58 negotiated rates

$47

list

Liver function panel

CPT 80076 · lowest of 2 lines · metro median $54

$54

cash

$8 to $77

28 negotiated rates

$90

list

MRI of the brain, with and without contrast

CPT 70553 · lowest of 2 lines · metro median $1,967

$1,967

cash

$223 to $2,787

30 negotiated rates

$3,279

list

MRI of the knee or other lower joint, no contrast

CPT 73721 · lowest of 2 lines · metro median $1,489

$1,479

cash

$143 to $2,095

30 negotiated rates

$2,465

list

MRI of the lower back (lumbar spine), no contrast

CPT 72148 · lowest of 2 lines · metro median $1,510

$1,510

cash

$134 to $2,139

30 negotiated rates

$2,517

list

MRI of the neck (cervical spine), no contrast

CPT 72141 · lowest of 2 lines · metro median $1,423

$1,423

cash

$133 to $2,016

30 negotiated rates

$2,372

list

Neck (cervical) spinal fusion, no complications

MS-DRG 473

—

cash

$1,740 to $61,551

14 negotiated rates

—

list

Nerve block injection, lower back, with imaging guidance

CPT 64483 · lowest of 2 lines · metro median $1,187

$1,187

cash

$350 to $4,233

30 negotiated rates

$1,979

list

New patient office visit (about 30 minutes)

CPT 99203 · lowest of 3 lines · metro median $75

$75

cash

$37 to $117

20 negotiated rates

$125

list

New patient office visit (about 45 minutes)

CPT 99204 · lowest of 3 lines · metro median $101

$101

cash

$50 to $154

20 negotiated rates

$169

list

New patient office visit (about 60 minutes)

CPT 99205 · lowest of 4 lines · metro median $145

$117

cash

$58 to $194

21 negotiated rates

$195

list

PSA test (prostate)

CPT 84153 · lowest of 12 lines · metro median $51

$51

cash

$18 to $94

168 negotiated rates

$85

list

Partial thromboplastin time (blood clotting test)

CPT 85730 · lowest of 14 lines · metro median $16

$16

cash

$6 to $56

252 negotiated rates

$26

list

Physical therapy, therapeutic exercise (15 minutes)

CPT 97110 · lowest of 2 lines · metro median $94

$94

cash

$18 to $125

17 negotiated rates

$156

list

Pregnancy ultrasound (after first trimester)

CPT 76805 · lowest of 4 lines · metro median $551

$551

cash

$61 to $781

60 negotiated rates

$919

list

Preventive visit, new patient age 18 to 39

CPT 99385

—

cash

$62 to $100

5 negotiated rates

—

list

Preventive visit, new patient age 40 to 64

CPT 99386

—

cash

$60 to $121

5 negotiated rates

—

list

Prostate biopsy

CPT 55700

—

cash

$470 to $5,092

24 negotiated rates

—

list

Prostate removal (laparoscopic)

CPT 55866

—

cash

$938 to $13,576

19 negotiated rates

—

list

Prothrombin time (blood clotting test)

CPT 85610 · lowest of 6 lines · metro median $11

$11

cash

$4 to $46

140 negotiated rates

$19

list

Psychotherapy, 30 minutes

CPT 90832

—

cash

$47 to $210

14 negotiated rates

—

list

Psychotherapy, 45 minutes

CPT 90834

—

cash

$75 to $210

14 negotiated rates

—

list

Psychotherapy, 60 minutes

CPT 90837

—

cash

$110 to $210

14 negotiated rates

—

list

Removal of a breast lump (biopsy by excision)

CPT 19120

—

cash

$537 to $6,553

24 negotiated rates

—

list

Screening mammogram (both breasts)

CPT 77067 · lowest of 6 lines · metro median $227

$227

cash

$81 to $354

56 negotiated rates

$378

list

Shoulder arthroscopy with decompression

CPT 29826

—

cash

$495 to $5,980

11 negotiated rates

—

list

Sleep study (overnight, attended)

CPT 95810

—

cash

$421 to $1,327

17 negotiated rates

—

list

Spinal injection, lower back, no imaging guidance

CPT 62322 · lowest of 2 lines · metro median $176

$176

cash

$79 to $4,233

60 negotiated rates

$294

list

Spinal injection, lower back, with imaging guidance

CPT 62323 · lowest of 2 lines · metro median $444

$444

cash

$101 to $4,233

60 negotiated rates

$740

list

TSH test (thyroid)

CPT 84443 · lowest of 6 lines · metro median $64

$64

cash

$16 to $117

112 negotiated rates

$106

list

Tonsils and adenoids removal (under age 12)

CPT 42820

—

cash

$537 to $7,714

24 negotiated rates

—

list

Transvaginal ultrasound

CPT 76830 · lowest of 3 lines · metro median $230

$230

cash

$50 to $595

31 negotiated rates

$383

list

Ultrasound of the abdomen (complete)

CPT 76700 · lowest of 2 lines · metro median $508

$501

cash

$65 to $710

30 negotiated rates

$835

list

Upper endoscopy (EGD)

CPT 43235

—

cash

$350 to $4,233

24 negotiated rates

—

list

Upper endoscopy with biopsy

CPT 43239

—

cash

$470 to $5,681

24 negotiated rates

—

list

Urinalysis with microscope

CPT 81001 · lowest of 10 lines · metro median $7

cash

$3 to $31

168 negotiated rates

$11

list

Vaginal delivery after a previous cesarean

CPT 59610

—

cash

$1,094 to $2,652

5 negotiated rates

—

list

Vaginal delivery hospital stay, no complications

MS-DRG 807

—

cash

$1,700 to $17,518

15 negotiated rates

—

list

Vaginal delivery with prenatal and postpartum care

CPT 59400

—

cash

$1,114 to $2,553

5 negotiated rates

—

list

X-ray of the lower spine (4 or more views)

CPT 72110 · lowest of 2 lines · metro median $335

$317

cash

$32 to $449

30 negotiated rates

$528

list

Source files

The machine-readable files this hospital lists in its cms-hpt.txt. Every price above comes from one of them.

https://hph.pt.panaceainc.com/MRFDownload/hph/palimomi/990274038_Pali-Momi-Medical-Center_standardcharges.csv
Pali Momi Medical Center · parsed · tall v3.0.0 · file dated 2026-02-12 · 317.8 MB · 4163 price rows read · read Nov 2026
https://hph.pt.panaceainc.com/MRFDownload/hph/straub/912151670_Straub-Benioff-Medical-Center_standardcharges.csv
Straub Benioff Medical Center · discovered
https://hph.pt.panaceainc.com/MRFDownload/hph/wilcox/990074365_Wilcox-Medical-Center_standardcharges.csv
Wilcox Medical Center · discovered