Moanalua Medical Center
3288 MOANALUA ROAD, HONOLULU, HI · Kaiserpermanente · · NPI 1396813861
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Liver Function Test CPT 80076 | $72.75 | $97.00 | $8.00 – $8.00 | 1 |
| Liver imaging CPT 78201 | $1,386.00 | $1,848.00 | $554.00 – $554.00 | 1 |
| Liver imag w/vasclr flow CPT 78202 | $1,600.50 | $2,134.00 | $554.00 – $554.00 | 1 |
| Liver/spleen imag static only CPT 78215 | $997.50 | $1,330.00 | $414.00 – $414.00 | 1 |
| Liver/spleen imag w/vasclr flow CPT 78216 | $997.50 | $1,330.00 | $414.00 – $414.00 | 1 |
| Lmtd oph exam general anes CPT 92019 | not published | not published | not published | 0 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | not published | 0 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | $148.97 | $198.62 | $1.80 – $1.80 | 1 |
| Lomustine 10 mg HCPCS S0178 | not published | not published | $21.00 – $21.00 | 1 |
| Loncastuximab tesirine-lpyl 10 mg intravenous solution HCPCS J9359 | $61,208.69 | $81,611.58 | $217.00 – $217.00 | 1 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $43.10 | $57.46 | $1.30 – $1.30 | 1 |
| Loudness balance test CPT 92562 | $450.00 | $600.00 | not published | 0 |
| Low back disk surgery CPT 63030 | not published | not published | not published | 0 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $2,182.50 | $2,910.00 | $204.00 – $204.00 | 1 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $1,890.00 | $2,520.00 | $367.00 – $367.00 | 1 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $1,597.50 | $2,130.00 | $124.00 – $124.00 | 1 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $2,610.00 | $3,480.00 | $367.00 – $367.00 | 1 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $1,965.00 | $2,620.00 | $367.00 – $367.00 | 1 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $1,747.50 | $2,330.00 | $249.00 – $249.00 | 1 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $325.50 | $434.00 | $109.00 – $109.00 | 1 |
| Lower jaw bone graft CPT 21215 | not published | not published | not published | 0 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | not published | 0 |
| Lsh uterus above 250 g CPT 58543 | not published | not published | not published | 0 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | not published | 0 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | not published | 0 |
| L/s ratio fetal lung CPT 83661 | $134.25 | $179.00 | $22.00 – $22.00 | 1 |
| Lumbar diskogram s&i CPT 72295 | $5,006.25 | $6,675.00 | $2,011.00 – $2,011.00 | 1 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | not published | 0 |
| Lumizyme injection HCPCS J0221 | $2,328.21 | $3,104.28 | $206.00 – $206.00 | 1 |
| Lung function test (mbc/mvv) CPT 94200 | $89.25 | $119.00 | not published | 0 |
| Lung Function Test (Spirometry) CPT 94010 | $290.25 | $387.00 | not published | 0 |
| Lung perfusion imaging CPT 78580 | $997.50 | $1,330.00 | $414.00 – $414.00 | 1 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | $19,338.75 | $25,785.00 | $206.00 – $206.00 | 1 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | $26,656.80 | $35,542.39 | $42.00 – $42.00 | 1 |
| Lutetium lu 177 dotatat ther HCPCS A9513 | $144,849.60 | $193,132.79 | not published | 0 |
| Lutetium lu 177 vipivotide HCPCS A9607 | $110,556.91 | $147,409.21 | not published | 0 |
| Lw ntsty Ultrasound stimj bone healg CPT 20979 | not published | not published | not published | 0 |
| Lyme dis dna dir probe CPT 87475 | $122.25 | $163.00 | $20.00 – $20.00 | 1 |
| Lymphatics/lymph node imaging CPT 78195 | $1,335.00 | $1,780.00 | $554.00 – $554.00 | 1 |
| Lymphocyte culture mixed CPT 86821 | $222.75 | $297.00 | $37.00 – $37.00 | 1 |
| Lymphocyte transformation mitogen CPT 86353 | $306.75 | $409.00 | $49.00 – $49.00 | 1 |
| Lymphocytotoxicity assay CPT 86805 | $934.50 | $1,246.00 | $189.00 – $189.00 | 1 |
| Lymphocytotoxicity assay CPT 86806 | $289.50 | $386.00 | $47.00 – $47.00 | 1 |
| Lymph vessel x-ray arm/leg CPT 75801 | $1,571.25 | $2,095.00 | $637.00 – $637.00 | 1 |
| Lymph vessel x-ray arms/legs CPT 75803 | $4,141.50 | $5,522.00 | $1,598.00 – $1,598.00 | 1 |
| Lymph vessel x-ray trunk CPT 75805 | $8,295.00 | $11,060.00 | $3,240.00 – $3,240.00 | 1 |
| Lymph vessel x-ray trunk CPT 75807 | $8,295.00 | $11,060.00 | $3,240.00 – $3,240.00 | 1 |
| Lysis intranasal synechia 30560 CPT 30560 | not published | not published | not published | 0 |
| Lysis of labial adhesions CPT 56441 | not published | not published | not published | 0 |
| Lysis penil circumic lesion CPT 54162 | not published | not published | not published | 0 |
| Lyumjev for insulin pump use HCPCS J1813 | not published | not published | $15.00 – $15.00 | 1 |
| Macro exam dissect molec study ea CPT 88387 | $105.75 | $141.00 | $8.00 – $8.00 | 1 |
| Macroscopic exam arthropod CPT 87168 | $25.50 | $34.00 | $4.00 – $4.00 | 1 |
| Macroscopic exam parasite CPT 87169 | $26.25 | $35.00 | $4.00 – $4.00 | 1 |
| Magnesium CPT 83735 | $60.00 | $80.00 | $7.00 – $7.00 | 1 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $126.00 | $168.00 | $0.50 – $0.50 | 1 |
| Magnetic image bone marrow CPT 77084 | $1,230.00 | $1,640.00 | $357.00 – $357.00 | 1 |
| Makena, 10 mg HCPCS J1726 | $1,882.77 | $2,510.36 | not published | 0 |
| Malaria antibody CPT 86750 | $81.00 | $108.00 | $13.00 – $13.00 | 1 |
| Male sling procedure CPT 53440 | not published | not published | not published | 0 |
| Mammosite ced HCPCS C1728 | $3.00 | $4.00 | not published | 0 |
| Manipulate finger w/anesth CPT 26340 | not published | not published | not published | 0 |
| Manipulate wrist w/anesthes CPT 25259 | not published | not published | not published | 0 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $435.00 | $580.00 | not published | 0 |
| Manipulation of hip joint CPT 27275 | not published | not published | not published | 0 |
| Manipulation of spine CPT 22505 | not published | not published | not published | 0 |
| Manipulat palm cord post inj CPT 26341 | not published | not published | not published | 0 |
| Manual diff wbc count b-coat CPT 85009 | $24.75 | $33.00 | $5.00 – $5.00 | 1 |
| Mapping functional cort/subcort ea add'l hr CPT 95962 | $812.25 | $1,083.00 | not published | 0 |
| Map tachycard site(s) CPT 93609 | $1,125.00 | $1,500.00 | not published | 0 |
| Margetuximab-cmkb 25 mg/ml intravenous solution HCPCS J9353 | $6,759.40 | $9,012.53 | $50.00 – $50.00 | 1 |
| Marker biop eviva buckle ss HCPCS A4648 | $630.00 | $840.00 | not published | 0 |
| Mastectomy partial CPT 19301 | not published | not published | not published | 0 |
| Mast mod rad CPT 19307 | not published | not published | not published | 0 |
| Mastoidectomy CPT 69501 | not published | not published | not published | 0 |
| Mastoidectomy complete 69502 CPT 69502 | not published | not published | not published | 0 |
| Mastoids complete CPT 70130 | $296.25 | $395.00 | $109.00 – $109.00 | 1 |
| Mastoid surgery revision CPT 69603 | not published | not published | not published | 0 |
| Mastopexy CPT 19316 | not published | not published | not published | 0 |
| Mast simple complete CPT 19303 | $4,449.75 | $5,933.00 | not published | 0 |
| Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm HCPCS Q4166 | $423.36 | $564.48 | not published | 0 |
| M.avium-intra dna amp prob CPT 87561 | $213.00 | $284.00 | $35.00 – $35.00 | 1 |
| M.avium-intra dna dir prob CPT 87560 | $135.00 | $180.00 | $27.00 – $27.00 | 1 |
| M.avium-intra dna quant CPT 87562 | $261.00 | $348.00 | $43.00 – $43.00 | 1 |
| Maxillofacial fixation CPT 21100 | not published | not published | not published | 0 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $91.50 | $122.00 | $15.00 – $15.00 | 1 |
| Mayo aathr protein s free CPT 85306 | $96.00 | $128.00 | $15.00 – $15.00 | 1 |
| Mayo activated protein c resistance assay CPT 85307 | $96.00 | $128.00 | $15.00 – $15.00 | 1 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | $116.25 | $155.00 | $39.00 – $39.00 | 1 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | $27.75 | $37.00 | not published | 0 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $86.25 | $115.00 | $27.00 – $27.00 | 1 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $129.00 | $172.00 | $15.00 – $15.00 | 1 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $98.25 | $131.00 | $27.00 – $27.00 | 1 |
| Mayo alpha 1 antitrypsin CPT 82103 | $84.00 | $112.00 | $14.00 – $14.00 | 1 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $113.25 | $151.00 | $15.00 – $15.00 | 1 |
| Mayo amphu amphetamines definitive assay 3 or 4 urine CPT 80325 | $182.25 | $243.00 | not published | 0 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | $86.25 | $115.00 | $27.00 – $27.00 | 1 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $369.00 | $492.00 | $121.00 – $121.00 | 1 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $277.50 | $370.00 | $91.00 – $91.00 | 1 |
| Mayo analysis gene smn1 dosage/deletion CPT 81329 | $381.00 | $508.00 | $137.00 – $137.00 | 1 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.