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Hospital Urban Honolulu, HI

Pali Momi Medical Center

Pali Momi Medical Center in Aiea, HI publishes cash prices for 42 common procedures listed here, from its own machine-readable price file updated Feb 12, 2026. Click a procedure to compare it with other hospitals nearby.

98-1079 Moanalua Road, Aiea HI 96701 Collected Sep 22, 2026 Source price file

Scans and imaging

ProcedureCash price List priceOff list
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN-PELVIS W/RAPID ORAL/IV CON-TECH $1,965.00 $3,275.00 40%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN-PELVIS(APPENDIX) W/CONTRAST-TECH $2,353.80 $3,923.00 40%
CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN AND PELVIS W/CONTRAST-TECH $2,388.60 $3,981.00 40%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN-PELVIS W/RAPID ORAL/IV CON-TECH $1,965.00 $3,275.00 40%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN-PELVIS(APPENDIX) W/CONTRAST-TECH $2,353.80 $3,923.00 40%
CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN AND PELVIS W/CONTRAST-TECH $2,388.60 $3,981.00 40%
CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD WITHOUT CONTRAST-TECH $1,059.00 $1,765.00 40%
CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD WITHOUT CONTRAST-TECH $1,059.00 $1,765.00 40%
CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS (LOWER ABD) WITH CONTRAST-TECH $1,291.80 $2,153.00 40%
CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS (LOWER ABD) WITH CONTRAST-TECH $1,291.80 $2,153.00 40%
Diagnostic mammogram, both breasts both sides CPT 77066 MAMMO BILAT DIAGNOSTIC 2-D W/WO CAD - TECH $417.00 $695.00 40%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO BILAT DIAGNOSTIC 2-D W/WO CAD W/SCRN-TC $417.00 $695.00 40%
Diagnostic mammogram, both breasts inpatient both sides CPT 77066 MAMMO BILAT DIAGNOSTIC 2-D W/WO CAD - TECH $417.00 $695.00 40%
Diagnostic mammogram, one breast one side CPT 77065 MAMMO UNILAT DIAGNOSTIC 2-D W/WO CAD - TECH $299.40 $499.00 40%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO UNILAT DIAGNOSTC 2-D W/WO CAD W/SCRN-TC $299.40 $499.00 40%
Diagnostic mammogram, one breast inpatient one side CPT 77065 MAMMO UNILAT DIAGNOSTIC 2-D W/WO CAD - TECH $299.40 $499.00 40%
MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MR EXTREMITY (LOWER) JOINT WITHOUT CONTRAST-TECH $1,479.00 $2,465.00 40%
MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 MR EXTREMITY (LOWER) JOINT WITHOUT CONTRAST-TECH $1,479.00 $2,465.00 40%
MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MR EXTREMITY (LOWER) JOINT WITHOUT & WITH CONTRAST-TECH $1,830.60 $3,051.00 40%
MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MR EXTREMITY (LOWER) JOINT WITHOUT & WITH CONTRAST-TECH $1,830.60 $3,051.00 40%
MRI of the brain, no contrast dye CPT 70551 MR BRAIN WITHOUT CONTRAST-TECH $1,481.40 $2,469.00 40%
MRI of the brain, no contrast dye inpatient CPT 70551 MR BRAIN WITHOUT CONTRAST-TECH $1,481.40 $2,469.00 40%
MRI of the brain, with and without contrast dye CPT 70553 MR BRAIN WITHOUT & WITH CONTRAST-TECH $1,967.40 $3,279.00 40%
MRI of the brain, with and without contrast dye inpatient CPT 70553 MR BRAIN WITHOUT & WITH CONTRAST-TECH $1,967.40 $3,279.00 40%
MRI of the lower back, no contrast dye CPT 72148 MR SPINE (LUMBAR) WITHOUT CONTRAST-TECH $1,510.20 $2,517.00 40%
MRI of the lower back, no contrast dye inpatient CPT 72148 MR SPINE (LUMBAR) WITHOUT CONTRAST-TECH $1,510.20 $2,517.00 40%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB >OR=14 WEEKS SINGLE FETUS -TECH $551.40 $919.00 40%
Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US OB COMPLETE > OR =14 WEEKS, MULTIPLE - TECH $551.40 $919.00 40%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB COMPLETE > OR =14 WEEKS, MULTIPLE - TECH $551.40 $919.00 40%
Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 US OB >OR=14 WEEKS SINGLE FETUS -TECH $551.40 $919.00 40%
Screening mammogram, both breasts both sides CPT 77067 MAMMO BILAT SCREENING 2-D W/WO CAD - TECH $249.60 $416.00 40%
Screening mammogram, both breasts both sides CPT 77067 MAMMO SELFREQUESTD BILAT SCRN 2-D W/WO CAD-TC $249.60 $416.00 40%
Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO BILAT SCREENING 2-D W/WO CAD - TECH $249.60 $416.00 40%
Screening mammogram, both breasts inpatient both sides CPT 77067 MAMMO SELFREQUESTD BILAT SCRN 2-D W/WO CAD-TC $249.60 $416.00 40%
Screening mammogram, both breasts inpatient CPT 77067 MAMMO SELFREQUESTD UNILT SCRN 2-D W/WO CAD-TC $226.80 $378.00 40%
Screening mammogram, both breasts inpatient one side CPT 77067 MAMMO UNILAT SCREENING 2-D W/WO CAD - TECH $226.80 $378.00 40%
Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL-TECH $420.00 $700.00 40%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL LIMITED SONOSITE $229.80 $383.00 40%
Transvaginal pelvic ultrasound inpatient CPT 76830 US TRANSVAGINAL-TECH $420.00 $700.00 40%
Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN, COMPLETE-TECH $501.00 $835.00 40%
Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN, COMPLETE-TECH $501.00 $835.00 40%
X-ray of the lower back, 4 or more views CPT 72110 XR SPINE, LUMBAR, 4+ VIEWS-TECH $316.80 $528.00 40%
X-ray of the lower back, 4 or more views inpatient CPT 72110 XR SPINE, LUMBAR, 4+ VIEWS-TECH $316.80 $528.00 40%

Lab tests

ProcedureCash price List priceOff list
Basic metabolic panel (blood test) CPT 80048 BASIC METABOLIC PANEL $56.40 $94.00 40%
Basic metabolic panel (blood test) inpatient CPT 80048 BASIC METABOLIC PANEL $56.40 $94.00 40%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL 2 W/RFX DLDL $91.20 $152.00 40%
Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE PANEL $95.40 $159.00 40%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL, SPECTROPHOTOMETRY $28.20 $47.00 40%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL $34.20 $57.00 40%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PANEL 2 W/RFX DLDL $91.20 $152.00 40%
Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE PANEL $95.40 $159.00 40%
Complete blood count (CBC) with differential CPT 85025 CBC AUTO W/PLATELET,AUTO DIFF $42.60 $71.00 40%
Complete blood count (CBC) with differential CPT 85025 CBC FOR FLOW CYTOMETRY $42.60 $71.00 40%
Complete blood count (CBC) with differential CPT 85025 CBC PLT W/AUTO DIFF $44.40 $74.00 40%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC FOR FLOW CYTOMETRY $42.60 $71.00 40%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC AUTO W/PLATELET,AUTO DIFF $42.60 $71.00 40%
Complete blood count (CBC) with differential inpatient CPT 85025 CBC PLT W/AUTO DIFF $44.40 $74.00 40%
Complete blood count (CBC), no differential CPT 85027 HPC CELL COUNT $31.20 $52.00 40%
Complete blood count (CBC), no differential CPT 85027 CBC/PLT AUTO W/O DIFF $36.60 $61.00 40%
Complete blood count (CBC), no differential CPT 85027 CBC AUTO $36.60 $61.00 40%
Complete blood count (CBC), no differential CPT 85027 CBC/PLT W/O DIFF/HEMOGRAM $38.40 $64.00 40%
Complete blood count (CBC), no differential inpatient CPT 85027 HPC CELL COUNT $31.20 $52.00 40%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC AUTO $36.60 $61.00 40%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC/PLT AUTO W/O DIFF $36.60 $61.00 40%
Complete blood count (CBC), no differential inpatient CPT 85027 CBC/PLT W/O DIFF/HEMOGRAM $38.40 $64.00 40%
Comprehensive metabolic panel (blood test) CPT 80053 COMP METABOLIC PANEL $68.40 $114.00 40%
Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMP METABOLIC PANEL $68.40 $114.00 40%
Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL $56.40 $94.00 40%
Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL $56.40 $94.00 40%
Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL $54.00 $90.00 40%
Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL $54.00 $90.00 40%
Obstetric blood test panel CPT 80055 OB PANEL $393.00 $655.00 40%
Obstetric blood test panel inpatient CPT 80055 OB PANEL $393.00 $655.00 40%
PSA (prostate-specific antigen) blood test, free CPT 84154 PSA, FREE $69.60 $116.00 40%
PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA, FREE $69.60 $116.00 40%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPEC AG, ULTRASENSATIVE $51.00 $85.00 40%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPEC AG W/RFLX FREE PSA $66.60 $111.00 40%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECIFIC ANTIGEN-DX $66.60 $111.00 40%
PSA (prostate-specific antigen) blood test, total CPT 84153 PSA, TOTAL $66.60 $111.00 40%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPEC ANTIGEN-SCREENING $66.60 $111.00 40%
PSA (prostate-specific antigen) blood test, total CPT 84153 PROSTATE SPECIFIC ANTIGEN, FREE $66.60 $111.00 40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPEC AG, ULTRASENSATIVE $51.00 $85.00 40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPEC AG W/RFLX FREE PSA $66.60 $111.00 40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPEC ANTIGEN-SCREENING $66.60 $111.00 40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECIFIC ANTIGEN, FREE $66.60 $111.00 40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PROSTATE SPECIFIC ANTIGEN-DX $66.60 $111.00 40%
PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA, TOTAL $66.60 $111.00 40%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT $15.60 $26.00 40%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME, PTT;PLASMA/WHOLE BLD $22.80 $38.00 40%
Partial thromboplastin time (PTT) clotting test CPT 85730 LUPUS ANTICOAGULANT $24.60 $41.00 40%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT, PLASMA/WHOLE BLD $27.60 $46.00 40%
Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME,PTT;PLASMA/WHOLE BLD $38.40 $64.00 40%
Partial thromboplastin time (PTT) clotting test CPT 85730 PTT (PARTIAL THROMBOPLASTIN) $38.40 $64.00 40%
Partial thromboplastin time (PTT) clotting test CPT 85730 PART THROMB TIME (PTT) $39.60 $66.00 40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT $15.60 $26.00 40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME, PTT;PLASMA/WHOLE BLD $22.80 $38.00 40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 LUPUS ANTICOAGULANT $24.60 $41.00 40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT, PLASMA/WHOLE BLD $27.60 $46.00 40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME,PTT;PLASMA/WHOLE BLD $38.40 $64.00 40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PTT (PARTIAL THROMBOPLASTIN) $38.40 $64.00 40%
Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 PART THROMB TIME (PTT) $39.60 $66.00 40%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTIME $11.40 $19.00 40%
Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME $30.60 $51.00 40%
Prothrombin time (PT/INR) clotting test CPT 85610 PT (PROTIME) $32.40 $54.00 40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTIME $11.40 $19.00 40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME $30.60 $51.00 40%
Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PT (PROTIME) $32.40 $54.00 40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH TO ESOTERIX $63.60 $106.00 40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 THYROID STIMULATING HORMONE $79.20 $132.00 40%
Thyroid-stimulating hormone (TSH) blood test CPT 84443 TSH WITH REFLEX FT4 $82.80 $138.00 40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH TO ESOTERIX $63.60 $106.00 40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 THYROID STIMULATING HORMONE $79.20 $132.00 40%
Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 TSH WITH REFLEX FT4 $82.80 $138.00 40%
Urinalysis with microscope exam, automated CPT 81001 URINE DIPSTICK, AUTOMATED W/MICROSCOPY $6.60 $11.00 40%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS MICRO, REFLEXED $19.80 $33.00 40%
Urinalysis with microscope exam, automated CPT 81001 URINE MICRO RFX CULTURE $19.80 $33.00 40%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS, COMPLETE $22.20 $37.00 40%
Urinalysis with microscope exam, automated CPT 81001 URINALYSIS AUTO W/REFLEX TO CULTURE AND SEN $22.20 $37.00 40%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINE DIPSTICK, AUTOMATED W/MICROSCOPY $6.60 $11.00 40%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS MICRO, REFLEXED $19.80 $33.00 40%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINE MICRO RFX CULTURE $19.80 $33.00 40%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS, COMPLETE $22.20 $37.00 40%
Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS AUTO W/REFLEX TO CULTURE AND SEN $22.20 $37.00 40%
Urinalysis with microscope exam, manual CPT 81000 URINALYSIS ROUTINE (MANUAL) $19.20 $32.00 40%
Urinalysis with microscope exam, manual CPT 81000 URINALYSIS W/REFLEX MANUAL $19.20 $32.00 40%
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS W/REFLEX MANUAL $19.20 $32.00 40%
Urinalysis with microscope exam, manual inpatient CPT 81000 URINALYSIS ROUTINE (MANUAL) $19.20 $32.00 40%
Urinalysis without microscope exam, automated CPT 81003 URINE MACRO CHARGE $15.00 $25.00 40%
Urinalysis without microscope exam, automated CPT 81003 URINE MACROSCOPIC ONLY $16.20 $27.00 40%
Urinalysis without microscope exam, automated CPT 81003 SPECIFIC GRAVITY, URINE, MANUAL $18.00 $30.00 40%
Urinalysis without microscope exam, automated CPT 81003 POCT URINE DIPSTICK,AUTOMATED W/O MICROSCOPY $25.20 $42.00 40%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE MACRO CHARGE $15.00 $25.00 40%
Urinalysis without microscope exam, automated inpatient CPT 81003 URINE MACROSCOPIC ONLY $16.20 $27.00 40%
Urinalysis without microscope exam, automated inpatient CPT 81003 SPECIFIC GRAVITY, URINE, MANUAL $18.00 $30.00 40%
Urinalysis without microscope exam, automated inpatient CPT 81003 POCT URINE DIPSTICK,AUTOMATED W/O MICROSCOPY $25.20 $42.00 40%
Urinalysis without microscope exam, manual CPT 81002 MANUAL URINE MACRO BILL ONLY $16.20 $27.00 40%
Urinalysis without microscope exam, manual CPT 81002 PROTEIN, URINE, QUALITATIVE $43.80 $73.00 40%
Urinalysis without microscope exam, manual CPT 81002 BILIRUBIN,URINE QUALITATIVE $43.80 $73.00 40%
Urinalysis without microscope exam, manual CPT 81002 OCCULT BLOOD,URINE QUALITATIVE $43.80 $73.00 40%
Urinalysis without microscope exam, manual CPT 81002 GLUCOSE, URINE,QUALITATIVE $43.80 $73.00 40%
Urinalysis without microscope exam, manual CPT 81002 KETONE, URINE, QUAL $43.80 $73.00 40%
Urinalysis without microscope exam, manual CPT 81002 NITRITE, URINE, QUALITATIVE $43.80 $73.00 40%
Urinalysis without microscope exam, manual CPT 81002 PH, URINE, QUALITATIVE $43.80 $73.00 40%
Urinalysis without microscope exam, manual inpatient CPT 81002 MANUAL URINE MACRO BILL ONLY $16.20 $27.00 40%
Urinalysis without microscope exam, manual inpatient CPT 81002 NITRITE, URINE, QUALITATIVE $43.80 $73.00 40%
Urinalysis without microscope exam, manual inpatient CPT 81002 GLUCOSE, URINE,QUALITATIVE $43.80 $73.00 40%
Urinalysis without microscope exam, manual inpatient CPT 81002 PROTEIN, URINE, QUALITATIVE $43.80 $73.00 40%
Urinalysis without microscope exam, manual inpatient CPT 81002 PH, URINE, QUALITATIVE $43.80 $73.00 40%
Urinalysis without microscope exam, manual inpatient CPT 81002 BILIRUBIN,URINE QUALITATIVE $43.80 $73.00 40%
Urinalysis without microscope exam, manual inpatient CPT 81002 OCCULT BLOOD,URINE QUALITATIVE $43.80 $73.00 40%
Urinalysis without microscope exam, manual inpatient CPT 81002 KETONE, URINE, QUAL $43.80 $73.00 40%

Surgery and procedures

ProcedureCash price List priceOff list
Left heart catheterization, diagnostic one side CPT 93452 LEFT HEART CATH WITH VENTRICULOGRAPHY - TECH $4,191.00 $6,985.00 40%
Left heart catheterization, diagnostic inpatient one side CPT 93452 LEFT HEART CATH WITH VENTRICULOGRAPHY - TECH $4,191.00 $6,985.00 40%
Lower-back epidural injection, with imaging guidance CPT 62323 INJ DX/THERA EPI/SUBARACH LUMBR/SACRL W/IMG $444.00 $740.00 40%
Lower-back epidural injection, with imaging guidance inpatient CPT 62323 INJ DX/THERA EPI/SUBARACH LUMBR/SACRL W/IMG $444.00 $740.00 40%
Lower-back epidural injection, without imaging guidance CPT 62322 INJ DX/THERA EPI/SUBARACH LUMBR/SACRL WO IMG $176.40 $294.00 40%
Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJ DX/THERA EPI/SUBARACH LUMBR/SACRL WO IMG $176.40 $294.00 40%
Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ ANES;LUMBAR/SACRAL,1 LEVEL W/IMAGING-TECH $1,187.40 $1,979.00 40%
Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 INJ ANES;LUMBAR/SACRAL,1 LEVEL W/IMAGING-TECH $1,187.40 $1,979.00 40%

Doctor visits and therapy

ProcedureCash price List priceOff list
New patient office visit, about 30 minutes CPT 99203 OFFICE/OP CONSULT LOW LVL MDM 30+MINS $75.00 $125.00 40%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE/OP CONSULT LOW LVL MDM 30+MINS $75.00 $125.00 40%
New patient office visit, about 30 minutes inpatient CPT 99203 OFFICE/OP E&M NEW LOW LEVEL 30+MINS $87.60 $146.00 40%
New patient office visit, about 45 minutes CPT 99204 OFFICE/OUTPT CONSULT MOD LVL MDM 40+MINS $101.40 $169.00 40%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OUTPT CONSULT MOD LVL MDM 40+MINS $101.40 $169.00 40%
New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OP E&M NEW MODERATE VISIT 45+MINS $115.20 $192.00 40%
New patient office visit, about 60 minutes CPT 99205 OFFICE/OUTPT CONSULT HIGH LVL MDM 55+MINS $117.00 $195.00 40%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE/OUTPT CONSULT HIGH LVL MDM 55+MINS $117.00 $195.00 40%
New patient office visit, about 60 minutes inpatient CPT 99205 TELEHEALTH-OFFICE/OP E&M NEW HIGH LVL 60+MINS $143.40 $239.00 40%
New patient office visit, about 60 minutes inpatient CPT 99205 OFFICE/OP E&M NEW HIGH LEVEL 60+MINS $144.60 $241.00 40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 OT THERAPEUTIC EXERCISE,EA 15 MIN $93.60 $156.00 40%
Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 PT THERAPEUTIC EXERCISE,EA 15 MIN $93.60 $156.00 40%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFF/OP CONSULT LOW LVL MDM 30MINS/+_NO ALT $75.00 $125.00 40%
Specialist consultation, low complexity or 30+ minutes inpatient CPT 99243 OFFICE/OP CONSULT LOW LVL MDM 30+MINS $75.00 $125.00 40%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFFICE/OUTPT CONSULT MOD LVL MDM 40+MINS $101.40 $169.00 40%
Specialist consultation, moderate complexity or 40+ minutes inpatient CPT 99244 OFF/OP CONSULT MOD LVL MDM 40MINS/+_NO ALT $101.40 $169.00 40%

Source file: https://hph.pt.panaceainc.com/MRFDownload/hph/palimomi/990274038_Pali-Momi-Medical-Center_standardcharges.csv