Molokai General Hospital
Molokai General Hospital in Kaunakakai, HI publishes cash prices for 221 common procedures listed here, from its own machine-readable price file (the file does not say when it was last updated). Compared with other hospitals in the state, its outpatient cash prices are above the Hawaii median for 156 of 210 procedures and below it for 43. By typical cash price it ranks #9 of 10 Hawaii hospitals, cheapest first. Click a procedure to compare it with other hospitals nearby.
280 Home Olu Pl,Kaunakakai,HI,96748 Collected Sep 27, 2026 Source price file (808) 553-5331
Critical access hospital (rural, 25 beds or fewer) Emergency department CCN 121303 · CMS hospital register
Scans and imaging
| Procedure | Cash price | List price | Insurers pay | vs Hawaii | Off list |
|---|---|---|---|---|---|
| Ankle X-ray, complete, 3 or more views CPT 73610 X-RAY EXAM OF ANKLE | $292.60 | $418.00 | $32.09–$48.56 | 21% above | 30% |
| Ankle-brachial index (ABI), blood pressure test for leg arteries CPT 93922 ULTRASOUND STUDY OF ARM AND LEG ARTERIES | $460.60 | $658.00 | $176.99 | 70% above | 30% |
| Breast ultrasound, limited (one breast or one area) CPT 76642 ULTRASOUND BREAST LIMITED | $448.70 | $641.00 | $110.53–$121.20 | at median | 30% |
| CT angiography of the chest (CTA), for blood clots in the lungs CPT 71275 CT ANGIOGRAPHY CHEST | $2,166.50 | $3,095.00 | $457.90–$910.63 | 24% above | 30% |
| CT angiography of the heart arteries with contrast dye (coronary CTA), including calcium score CPT 75574 CT ANGIO HRT W/3D IMAGE | $2,174.90 | $3,107.00 | $476.42–$634.80 | 2% above | 30% |
| CT of the heart without contrast dye to measure coronary calcium CPT 75571 CT HRT W/O DYE W/CA TEST | $1,914.50 | $2,735.00 | $64.35–$106.24 | 1427% above | 30% |
| CT scan of abdomen and pelvis, no contrast dye CPT 74176 CT ABD & PELVIS W/O CONTRAST | $2,124.50 | $3,035.00 | $246.72–$861.41 | 2% above | 30% |
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABD & PELVIS W/CONTRAST | $2,935.80 | $4,194.00 | $483.53–$1,020.52 | 26% above | 30% |
| CT scan of abdomen and pelvis, without and then with contrast dye CPT 74178 CT ABD&PLV WO CNTR FLWD CNTR | $3,047.80 | $4,354.00 | $553.79–$1,263.26 | 6% below | 30% |
| CT scan of the abdomen with contrast CPT 74160 CT ABDOMEN W/CONTRAST | $1,863.40 | $2,662.00 | $366.70–$510.26 | 3% above | 30% |
| CT scan of the abdomen without contrast CPT 74150 CT ABDOMEN W/O CONTRAST | $1,645.00 | $2,350.00 | $197.77–$421.35 | 18% above | 30% |
| CT scan of the face and sinuses, no contrast dye CPT 70486 CT MAXILLOFACIAL W/O DYE | $1,463.70 | $2,091.00 | $213.56–$351.80 | 23% above | 30% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O DYE | $1,480.50 | $2,115.00 | $160.66–$351.80 | 15% above | 30% |
| CT scan of the head with contrast CPT 70460 CT HEAD/BRAIN W/DYE | $1,864.80 | $2,664.00 | $230.93–$421.35 | 2% above | 30% |
| CT scan of the head without and with contrast CPT 70470 CT HEAD/BRAIN W/O & W/DYE | $1,981.70 | $2,831.00 | $280.65–$526.81 | 6% above | 30% |
| CT scan of the lower back (lumbar spine) without contrast CPT 72131 CT LUMBAR SPINE W/O DYE | $1,683.50 | $2,405.00 | $264.86–$440.08 | 23% above | 30% |
| CT scan of the neck (cervical spine), no contrast dye CPT 72125 CT NECK SPINE W/O DYE | $1,864.10 | $2,663.00 | $264.86–$440.08 | 37% above | 30% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/DYE | $1,896.30 | $2,709.00 | $368.28–$510.26 | 32% above | 30% |
| Chest X-ray, 2 views CPT 71046 X-RAY EXAM CHEST 2 VIEWS | $367.50 | $525.00 | $46.54 | 43% above | 30% |
| Chest X-ray, single view CPT 71045 X-RAY EXAM CHEST 1 VIEW | $367.50 | $525.00 | $35.14 | 69% above | 30% |
| Complete ultrasound of the back of the abdomen, such as both kidneys CPT 76770 US EXAM ABDO BACK WALL COMP | $657.30 | $939.00 | $121.38–$169.35 | 2% below | 30% |
| DEXA bone density scan of the hip, pelvis or spine CPT 77080 DXA BONE DENSITY AXIAL | $473.90 | $677.00 | $68.31–$230.71 | 63% above | 30% |
| DEXA bone density scan of the wrist, heel or finger (peripheral) CPT 77081 DXA BONE DENSITY APPENDICULR | $256.90 | $367.00 | $37.10–$56.46 | 75% above | 30% |
| Detailed fetal anatomy ultrasound, through the belly, one baby CPT 76811 OB US DETAILED SNGL FETUS | $689.50 | $985.00 | $184.78–$273.65 | 9% above | 30% |
| Diagnostic CT scan of the chest, no contrast dye CPT 71250 CT THORAX DX C- | $1,603.70 | $2,291.00 | $264.86–$440.08 | 20% above | 30% |
| Diagnostic CT scan of the chest, with contrast dye CPT 71260 CT THORAX DX C+ | $1,834.70 | $2,621.00 | $366.70–$526.81 | 23% above | 30% |
| Diagnostic mammogram, both breasts both sides CPT 77066 DX MAMMO INCL CAD BI | $415.10 | $593.00 | $187.65 | — | 30% |
| Diagnostic mammogram, one breast CPT 77065 DX MAMMO INCL CAD UNI | $283.50 | $405.00 | $152.22 | 5% below | 30% |
| Duplex ultrasound of the leg veins, both legs CPT 93970 EXTREMITY STUDY | $576.80 | $824.00 | $283.01 | 18% below | 30% |
| Knee X-ray, 3 views CPT 73562 X-RAY EXAM OF KNEE 3 | $352.10 | $503.00 | $35.29–$53.31 | 27% above | 30% |
| Limited abdominal ultrasound of one organ or area, such as the gallbladder CPT 76705 ECHO EXAM OF ABDOMEN | $600.60 | $858.00 | $87.09–$137.77 | 8% above | 30% |
| Low-dose CT of the chest for lung cancer screening, no contrast dye CPT 71271 CT THORAX LUNG CANCER SCR C- | $315.70 | $451.00 | $193.89 | 43% below | 30% |
| Pelvic ultrasound (not pregnancy), limited or follow-up CPT 76857 US EXAM PELVIC LIMITED | $369.60 | $528.00 | $50.16–$144.68 | 13% below | 30% |
| Pelvic ultrasound through the belly, complete (not pregnancy) CPT 76856 US EXAM PELVIC COMPLETE | $448.70 | $641.00 | $93.84–$167.77 | 14% below | 30% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 OB US >= 14 WKS SNGL FETUS | $625.10 | $893.00 | $129.47–$203.30 | 4% above | 30% |
| Pregnancy ultrasound before 14 weeks, through the belly, one baby CPT 76801 OB US < 14 WKS SINGLE FETUS | $455.70 | $651.00 | $129.47–$162.24 | 23% above | 30% |
| Pregnancy ultrasound, limited (heartbeat, position, fluid) CPT 76815 OB US LIMITED FETUS(S) | $412.30 | $589.00 | $87.09–$114.10 | at median | 30% |
| Screening mammogram, both breasts both sides CPT 77067 SCR MAMMO BI INCL CAD | $287.70 | $411.00 | $176.19 | — | 30% |
| Shoulder X-ray, complete, 2 or more views CPT 73030 X-RAY EXAM OF SHOULDER | $360.50 | $515.00 | $34.29–$42.94 | 62% above | 30% |
| Transvaginal pelvic ultrasound CPT 76830 TRANSVAGINAL US NON-OB | $506.80 | $724.00 | $93.84–$193.82 | 12% above | 30% |
| Transvaginal ultrasound during pregnancy CPT 76817 TRANSVAGINAL US OBSTETRIC | $402.50 | $575.00 | $92.15–$130.66 | at median | 30% |
| Ultrasound of the abdomen, complete CPT 76700 US EXAM ABDOM COMPLETE | $752.50 | $1,075.00 | $121.38–$182.76 | 35% above | 30% |
| Ultrasound of the scrotum and testicles CPT 76870 US EXAM SCROTUM | $439.60 | $628.00 | $77.79–$130.55 | 2% below | 30% |
| Ultrasound of the soft tissues of the head and neck, such as the thyroid CPT 76536 US EXAM OF HEAD AND NECK | $506.80 | $724.00 | $87.09–$196.19 | 6% below | 30% |
| Vein ultrasound (duplex) of one arm or leg, or a limited study CPT 93971 EXTREMITY STUDY | $443.80 | $634.00 | $201.28 | 10% below | 30% |
| Wrist X-ray, complete, 3 or more views CPT 73110 X-RAY EXAM OF WRIST | $289.80 | $414.00 | $32.09–$57.25 | 10% above | 30% |
| X-ray of one hip, 2 or 3 views, with the pelvis when included CPT 73502 X-RAY EXAM HIP UNI 2-3 VIEWS | $329.00 | $470.00 | $58.80 | 9% above | 30% |
| X-ray of the abdomen, 1 view CPT 74018 RADEX ABDOMEN 1 VIEW | $360.50 | $515.00 | $38.72 | 63% above | 30% |
| X-ray of the ankle, 2 views CPT 73600 X-RAY EXAM OF ANKLE | $240.10 | $343.00 | $29.74–$40.68 | 35% above | 30% |
| X-ray of the finger(s), 2 or more views CPT 73140 X-RAY EXAM OF FINGER(S) | $274.40 | $392.00 | $25.61–$52.52 | 71% above | 30% |
| X-ray of the foot, 2 views CPT 73620 X-RAY EXAM OF FOOT | $360.50 | $515.00 | $29.74–$39.10 | 84% above | 30% |
| X-ray of the foot, complete, 3 or more views CPT 73630 X-RAY EXAM OF FOOT | $312.90 | $447.00 | $32.09–$44.63 | 35% above | 30% |
| X-ray of the hand, 3 or more views CPT 73130 X-RAY EXAM OF HAND | $305.20 | $436.00 | $32.09–$46.99 | 17% above | 30% |
| X-ray of the knee, 1 or 2 views CPT 73560 X-RAY EXAM OF KNEE 1 OR 2 | $360.50 | $515.00 | $31.50–$43.05 | 75% above | 30% |
| X-ray of the lower back (lumbar spine), 2 or 3 views CPT 72100 X-RAY EXAM L-S SPINE 2/3 VWS | $363.30 | $519.00 | $41.19–$50.94 | 29% above | 30% |
| X-ray of the lower back, 4 or more views CPT 72110 X-RAY EXAM L-2 SPINE 4/>VWS | $490.00 | $700.00 | $56.18–$71.46 | 11% above | 30% |
| X-ray of the mid back (thoracic spine), 2 views CPT 72070 X-RAY EXAM THORAC SPINE 2VWS | $308.70 | $441.00 | $38.53–$48.79 | 27% above | 30% |
| X-ray of the nasal bones, 3 or more views CPT 70160 X-RAY EXAM OF NASAL BONES | $250.60 | $358.00 | $31.50–$51.74 | 1% below | 30% |
| X-ray of the neck (cervical spine), 2 or 3 views CPT 72040 X-RAY EXAM NECK SPINE 2-3 VW | $254.80 | $364.00 | $37.07–$46.99 | 8% below | 30% |
| X-ray of the pelvis, 1 or 2 views CPT 72170 X-RAY EXAM OF PELVIS | $295.40 | $422.00 | $29.88–$39.88 | 53% above | 30% |
| X-ray of the tailbone (sacrum and coccyx), 2 or more views CPT 72220 X-RAY EXAM SACRUM TAILBONE | $297.50 | $425.00 | $34.89–$42.94 | 31% above | 30% |
Lab tests
| Procedure | Cash price | List price | Insurers pay | vs Hawaii | Off list |
|---|---|---|---|---|---|
| ALT (alanine aminotransferase) liver enzyme test CPT 84460 LIVER ENZYME (SGPT); LEVEL | $85.40 | $122.00 | $12.26–$12.89 | 79% above | 30% |
| AST (aspartate aminotransferase) enzyme test CPT 84450 LIVER ENZYME (SGOT); LEVEL | $85.40 | $122.00 | $11.97–$12.53 | 60% above | 30% |
| Acute hepatitis panel (hepatitis A, B and C) CPT 80074 ACUTE HEPATITIS PANEL | $590.10 | $843.00 | $110.21–$115.74 | 16% above | 30% |
| Allergy blood test, specific IgE, per allergen CPT 86003 ALLG SPEC IGE CRUDE XTRC EA | $146.30 | $209.00 | $12.07–$12.67 | 232% above | 30% |
| Antinuclear antibody (ANA) blood test, screen CPT 86038 ANTINUCLEAR ANTIBODIES | $254.80 | $364.00 | $27.96–$29.36 | 93% above | 30% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL | $97.30 | $139.00 | $78.52–$82.51 | 44% below | 30% |
| BNP or NT-proBNP blood test (heart failure marker) CPT 83880 ASSAY OF NATRIURETIC PEPTIDE | $252.70 | $361.00 | $78.52–$82.51 | 44% above | 30% |
| Basic metabolic panel (blood test) CPT 80048 BLOOD TEST; BASIC GROUP OF BLOOD CHEMICALS (CALCIUM; TOTAL) | $88.90 | $127.00 | $19.57–$20.56 | 8% above | 30% |
| Blood culture for bacteria CPT 87040 BLOOD CULTURE FOR BACTERIA | $151.20 | $216.00 | $23.88–$25.06 | 22% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE | $18.20 | $26.00 | $10.97 | 62% above | 30% |
| Blood draw from a vein (venipuncture), collection fee only CPT 36415 COLL VENOUS BLD VENIPUNCTURE | $30.80 | $44.00 | $10.97 | 175% above | 30% |
| Blood glucose (sugar) test CPT 82947 BLOOD GLUCOSE (SUGAR) LEVEL | $79.10 | $113.00 | $9.08–$9.51 | 62% above | 30% |
| Blood lead test CPT 83655 ASSAY OF LEAD | $151.90 | $217.00 | $28.00–$29.43 | 18% above | 30% |
| Blood pregnancy test (hCG, qualitative: yes or no) CPT 84703 GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS | $138.60 | $198.00 | $17.39–$18.24 | 62% above | 30% |
| Blood type test, ABO group only (Rh factor is a separate test) CPT 86900 BLOOD GROUP TYPING (ABO) | $197.40 | $282.00 | $6.90–$7.26 | 112% above | 30% |
| C-reactive protein (CRP) blood test, standard (not high-sensitivity) CPT 86140 MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION | $55.30 | $79.00 | $11.97–$12.61 | 76% above | 30% |
| C. difficile toxin gene test (stool PCR) CPT 87493 C DIFF AMPLIFIED PROBE | $472.50 | $675.00 | $81.19–$85.26 | 33% above | 30% |
| CA-125 blood test (ovarian cancer marker) CPT 86304 IMMUNOASSAY TUMOR CA 125 | $144.90 | $207.00 | $48.14–$50.55 | at median | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN | $73.50 | $105.00 | $128.00 | at median | 30% |
| COVID-19 PCR test (SARS-CoV-2 lab test) CPT 87635 SARS-COV-2 COVID-19 AMP PRB | $107.10 | $153.00 | $128.00 | 46% above | 30% |
| Chlamydia test by nucleic acid amplification (NAAT, PCR-type) CPT 87491 CHLMYD TRACH DNA AMP PROBE | $335.30 | $479.00 | $81.19–$85.26 | 203% above | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 BLOOD TEST; LIPIDS (CHOLESTEROL AND TRIGLYCERIDES) | $102.20 | $146.00 | $30.97–$32.52 | 7% below | 30% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PANEL | $107.10 | $153.00 | $30.97–$32.52 | 2% below | 30% |
| Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC | $81.20 | $116.00 | $17.99–$18.87 | 32% above | 30% |
| Complete blood count (CBC) with differential CPT 85025 COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT | $217.00 | $310.00 | $17.99–$18.87 | 252% above | 30% |
| Complete blood count (CBC), no differential CPT 85027 COMPLETE CBC AUTOMATED | $107.10 | $153.00 | $14.98–$15.71 | 125% above | 30% |
| Complete blood count (CBC), no differential CPT 85027 COMPLETE BLOOD CELL COUNT (RED CELLS; WHITE BLOOD CELL; PLATELETS); AUTOMATED TEST | $112.70 | $161.00 | $14.98–$15.71 | 137% above | 30% |
| Comprehensive metabolic panel (blood test) CPT 80053 BLOOD TEST; COMPREHENSIVE GROUP OF BLOOD CHEMICALS | $105.00 | $150.00 | $24.43–$25.70 | 9% above | 30% |
| D-dimer blood test (blood clot marker) CPT 85379 COAGULATION FUNCTION MEASUREMENT; D-DIMER; QUANTITATIVE | $65.10 | $93.00 | $23.54–$24.72 | 35% below | 30% |
| FSH (follicle-stimulating hormone) test CPT 83001 ASSAY OF GONADOTROPIN (FSH) | $107.10 | $153.00 | $42.99–$45.13 | 24% below | 30% |
| Ferritin blood test (iron stores) CPT 82728 ASSAY OF FERRITIN | $86.80 | $124.00 | $26.44–$27.81 | 16% below | 30% |
| Folate (folic acid) blood test CPT 82746 ASSAY OF FOLIC ACID SERUM | $137.20 | $196.00 | $34.02–$35.70 | at median | 30% |
| Free T4 (free thyroxine) thyroid blood test CPT 84439 ASSAY OF FREE THYROXINE | $131.60 | $188.00 | $20.86–$21.90 | 66% above | 30% |
| Glucose challenge test (1-hour glucose after a sugar drink) CPT 82950 GLUCOSE TEST | $94.50 | $135.00 | $10.98–$11.55 | 55% above | 30% |
| Glucose tolerance test, 3 samples CPT 82951 GLUCOSE TOLERANCE TEST (GTT) | $177.80 | $254.00 | $29.78–$31.26 | 46% above | 30% |
| Gonorrhea test by nucleic acid amplification (NAAT, PCR-type) CPT 87591 N.GONORRHOEAE DNA AMP PROB | $335.30 | $479.00 | $81.19–$85.26 | 203% above | 30% |
| H. pylori antibody blood test CPT 86677 HELICOBACTER PYLORI ANTIBODY | $133.00 | $190.00 | $33.56–$35.28 | 8% below | 30% |
| HIV-1 and HIV-2 antibody test CPT 86703 HIV-1/HIV-2 1 RESULT ANTBDY | $83.30 | $119.00 | $31.72–$33.31 | 31% above | 30% |
| HIV-1/2 antigen and antibody combination blood test (4th generation) CPT 87389 HIV-1 AG W/HIV-1&-2 AB AG IA | $193.20 | $276.00 | $51.67–$55.71 | 1% below | 30% |
| Hemoglobin A1C blood test (average blood sugar over about 3 months) CPT 83036 HEMOGLOBIN GLYCOSYLATED A1C | $119.00 | $170.00 | $22.46–$23.59 | 22% above | 30% |
| Hepatitis B surface antibody (anti-HBs) test, immunity check CPT 86706 HEP B SURFACE ANTIBODY | $83.30 | $119.00 | $24.85–$26.12 | 9% below | 30% |
| Hepatitis B surface antigen (HBsAg) test CPT 87340 HEPATITIS B SURFACE AG IA | $63.00 | $90.00 | $23.90–$25.06 | 21% below | 30% |
| Hepatitis C antibody blood test (screening) CPT 86803 HEPATITIS C AB TEST | $83.30 | $119.00 | $33.01–$34.71 | 23% below | 30% |
| High-sensitivity CRP (hs-CRP) test CPT 86141 C-REACTIVE PROTEIN HS | $52.50 | $75.00 | $29.95–$31.48 | 50% below | 30% |
| Homocysteine blood test CPT 83090 ASSAY OF HOMOCYSTEINE | $149.80 | $214.00 | $39.02–$40.97 | 4% below | 30% |
| Iron blood test (serum iron) CPT 83540 ASSAY OF IRON | $69.30 | $99.00 | $14.98–$15.77 | 77% above | 30% |
| Iron-binding capacity (TIBC) test CPT 83550 IRON BINDING TEST | $203.70 | $291.00 | $20.23–$21.26 | 130% above | 30% |
| Kidney function blood test panel CPT 80069 KIDNEY FUNCTION BLOOD TEST PANEL | $84.00 | $120.00 | $20.09–$21.12 | 21% above | 30% |
| Lipase blood test (pancreas enzyme) CPT 83690 LIPASE (FAT ENZYME) LEVEL | $97.30 | $139.00 | $15.95–$16.76 | 36% above | 30% |
| Lipase blood test (pancreas enzyme) CPT 83690 ASSAY OF LIPASE | $102.20 | $146.00 | $15.95–$16.76 | 43% above | 30% |
| Liver function blood test panel CPT 80076 LIVER FUNCTION BLOOD TEST PANEL | $119.00 | $170.00 | $18.89–$19.85 | 77% above | 30% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $125.30 | $179.00 | $18.89–$19.85 | 86% above | 30% |
| Magnesium blood test CPT 83735 ASSAY OF MAGNESIUM | $74.20 | $106.00 | $15.49–$16.27 | 20% above | 30% |
| Magnesium blood test CPT 83735 MAGNESIUM LEVEL | $77.70 | $111.00 | $15.49–$16.27 | 26% above | 30% |
| Mono test (heterophile antibody, Monospot) CPT 86308 HETEROPHILE ANTIBODY SCREEN | $74.90 | $107.00 | $11.97–$12.61 | 43% above | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL | $105.00 | $150.00 | $42.55–$44.71 | at median | 30% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT; TOTAL | $140.00 | $200.00 | $42.55–$44.71 | 33% above | 30% |
| Parathyroid hormone (PTH) blood test CPT 83970 PARATHORMONE (PARATHYROID HORMONE) LEVEL | $452.90 | $647.00 | $95.49–$100.25 | 8% above | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 COAGULATION ASSESSMENT BLOOD TEST; PLASMA OR WHOLE BLOOD | $60.20 | $86.00 | $13.89–$14.58 | 26% above | 30% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL | $63.00 | $90.00 | $13.89–$14.58 | 32% above | 30% |
| Prolactin blood test CPT 84146 ASSAY OF PROLACTIN | $240.10 | $343.00 | $44.83–$47.10 | 33% above | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 BLOOD TEST; CLOTTING TIME | $51.10 | $73.00 | $9.10–$9.57 | 32% above | 30% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME | $53.90 | $77.00 | $9.10–$9.57 | 40% above | 30% |
| Rapid drug screen read by eye (cup, dipstick or card), per day CPT 80305 TESTING FOR PRESENCE OF DRUG; READ BY DIRECT OBSERVATION | $503.30 | $719.00 | $32.13 | 463% above | 30% |
| Rapid strep A antigen test from a throat swab, read visually CPT 87880 DETECTION TEST BY IMMUNOASSAY WITH DIRECT VISUAL OBSERVATION FOR STREPTOCOCCUS; GROUP A (STREP) | $158.90 | $227.00 | $27.74–$29.15 | 440% above | 30% |
| Rheumatoid factor (RF) test CPT 86431 RHEUMATOID FACTOR QUANT | $88.20 | $126.00 | $13.12–$13.80 | 43% above | 30% |
| Rubella antibody test (immunity check) CPT 86762 RUBELLA ANTIBODY | $98.00 | $140.00 | $33.29–$35.00 | 27% above | 30% |
| Sed rate (ESR, erythrocyte sedimentation rate) CPT 85652 RED BLOOD CELL SEDIMENTATION RATE; TO DETECT INFLAMMATION; AUTOMATED | $55.30 | $79.00 | $6.26–$6.55 | 5% above | 30% |
| Stool ova and parasites exam CPT 87177 OVA AND PARASITES SMEARS | $111.30 | $159.00 | $20.59–$21.62 | 32% above | 30% |
| Stool test for hidden blood (guaiac FOBT) CPT 82270 OCCULT BLOOD FECES | $55.30 | $79.00 | $7.53–$7.88 | 76% above | 30% |
| Stool test for hidden blood by immunoassay (FIT) CPT 82274 ASSAY TEST FOR BLOOD FECAL | $102.90 | $147.00 | $31.26–$36.80 | 8% above | 30% |
| Syphilis screening blood test, non-treponemal (RPR or VDRL), yes/no result CPT 86592 SYPHILIS TEST NON-TREP QUAL | $43.40 | $62.00 | $9.88–$10.36 | 17% above | 30% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 BLOOD TEST; THYROID STIMULATING HORMONE (TSH) | $147.00 | $210.00 | $38.88–$40.83 | 15% above | 30% |
| Uric acid blood test CPT 84550 URIC ACID LEVEL; BLOOD | $88.20 | $126.00 | $10.46–$10.98 | 97% above | 30% |
| Urinalysis with microscope exam, automated CPT 81001 MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE; AUTOMATED | $52.50 | $75.00 | $7.33–$7.68 | 64% above | 30% |
| Urinalysis with microscope exam, manual CPT 81000 URINALYSIS NONAUTO W/SCOPE | $28.70 | $41.00 | $7.33–$7.68 | 49% above | 30% |
| Urinalysis without microscope exam, automated CPT 81003 AUTOMATED URINALYSIS TEST | $65.80 | $94.00 | $5.20–$5.49 | 176% above | 30% |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS; MANUAL TEST | $18.90 | $27.00 | $5.92–$6.20 | 4% above | 30% |
| Urine culture for bacteria, with colony count CPT 87086 URINE CULTURE/COLONY COUNT | $358.40 | $512.00 | $18.68–$19.65 | 237% above | 30% |
| Urine pregnancy test, read by color change CPT 81025 URINE PREGNANCY TEST | $63.70 | $91.00 | $14.64–$15.35 | 61% above | 30% |
| Vitamin B12 (cobalamin) blood test CPT 82607 VITAMIN B-12 | $185.50 | $265.00 | $34.87–$36.61 | 27% above | 30% |
| Vitamin D blood test, 25-hydroxy (the standard vitamin D level test) CPT 82306 VITAMIN D 25 HYDROXY | $326.90 | $467.00 | $68.49–$71.95 | 16% above | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 CHORIONIC GONADOTROPIN TEST | $149.80 | $214.00 | $34.83–$36.54 | 267% above | 30% |
| hCG pregnancy hormone blood test, quantitative (measures the level) CPT 84702 GONADOTROPIN; CHORIONIC (REPRODUCTIVE HORMONE) LEVEL | $245.70 | $351.00 | $34.83–$36.54 | 502% above | 30% |
Surgery and procedures
| Procedure | Cash price | List price | Insurers pay | vs Hawaii | Off list |
|---|---|---|---|---|---|
| Broken ankle (outer ankle bone) treatment without surgery or setting CPT 27786 TREATMENT OF ANKLE FRACTURE | $1,014.30 | $1,449.00 | $1,137.00 | 58% above | 30% |
| Broken foot (metatarsal) treatment without surgery or setting CPT 28470 TREAT METATARSAL FRACTURE | $751.10 | $1,073.00 | $1,137.00 | 3% above | 30% |
| Cardioversion, elective (restoring heart rhythm) CPT 92960 CARDIOVERSION ELECTRIC EXT | $914.90 | $1,307.00 | $1,412.00–$3,257.00 | 19% below | 30% |
| Circumcision with a clamp or device and a numbing nerve block, usually newborns inpatient CPT 54150 REMOVAL OF FORESKIN USING CLAMP OR DEVICE | $3,586.80 | $5,124.00 | $3,278.49–$6,615.00 | — | 30% |
| Circumcision, surgical, older than a newborn inpatient CPT 54160 CIRCUMCISION NEONATE | $1,523.20 | $2,176.00 | $3,278.49–$6,615.00 | — | 30% |
| Closed treatment of a wrist (distal radius) fracture, no resetting CPT 25600 CLTX DST RDL FX/EPHYS SEP WO | $938.70 | $1,341.00 | $1,137.00 | 4% above | 30% |
| Colonoscopy with polyp removal CPT 45385 COLONOSCOPY W/LESION REMOVAL | $978.60 | $1,398.00 | $1,412.00–$3,257.00 | 75% below | 30% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY AND BIOPSY | $978.60 | $1,398.00 | $1,412.00–$3,257.00 | 85% below | 30% |
| Colonoscopy, diagnostic CPT 45378 DIAGNOSTIC COLONOSCOPY | $756.70 | $1,081.00 | $1,412.00–$3,257.00 | 49% below | 30% |
| Earwax removal with instruments, one ear CPT 69210 REMOVE IMPACTED EAR WAX UNI | $230.30 | $329.00 | $1,137.00 | 14% above | 30% |
| Endometrial biopsy (uterine lining sample) without dilating the cervix CPT 58100 BIOPSY OF UTERUS LINING | $594.30 | $849.00 | $1,137.00 | 6% above | 30% |
| Hammertoe correction surgery CPT 28285 REPAIR OF HAMMERTOE | $8,393.70 | $11,991.00 | $1,616.00–$4,564.00 | 1% above | 30% |
| Hemorrhoid banding (rubber band ligation) CPT 46221 LIGATION OF HEMORRHOID(S) | $1,551.90 | $2,217.00 | $1,137.00 | 16% below | 30% |
| Incision and drainage of a simple or single skin abscess CPT 10060 I&D ABSCESS SIMPLE/SINGLE | $515.20 | $736.00 | $215.49 | 68% above | 30% |
| Injection or fluid drainage of a major joint (knee, shoulder, hip), no ultrasound CPT 20610 DRAIN/INJ JOINT/BURSA W/O US | $830.90 | $1,187.00 | $1,137.00 | 7% above | 30% |
| Joint injection or drainage, medium joint (wrist, elbow, ankle) CPT 20605 DRAIN/INJ JOINT/BURSA W/O US | $715.40 | $1,022.00 | $1,137.00 | 9% above | 30% |
| Joint injection or drainage, small joint (fingers, toes) CPT 20600 DRAIN/INJ JOINT/BURSA W/O US | $740.60 | $1,058.00 | $79.74 | 5% above | 30% |
| Layered stitches for a cut up to 2.5 cm, intermediate repair, scalp, body, arms or legs CPT 12031 INTMD RPR S/A/T/EXT 2.5 CM/< | $879.20 | $1,256.00 | $1,137.00 | 38% above | 30% |
| Nail removal (partial or complete), one nail CPT 11730 REMOVAL OF NAIL PLATE | $641.20 | $916.00 | $1,137.00 | 10% above | 30% |
| Paracentesis with imaging guidance CPT 49083 ABD PARACENTESIS W/IMAGING | $1,487.50 | $2,125.00 | $1,054.00–$1,801.00 | 20% above | 30% |
| Permanent removal of a nail and nail root (partial or complete) CPT 11750 REMOVAL OF NAIL BED | $1,302.70 | $1,861.00 | $1,137.00 | 36% above | 30% |
| Removal of a foreign object under the skin, simple CPT 10120 INC&RMVL FB SUBQ TISS SMPL | $872.20 | $1,246.00 | $1,137.00 | 2% below | 30% |
| Short arm splint (forearm and hand) CPT 29125 APPLY FOREARM SPLINT | $378.00 | $540.00 | $1,137.00 | 91% above | 30% |
| Short leg splint (calf to foot) CPT 29515 APPLICATION LOWER LEG SPLINT | $561.40 | $802.00 | $1,137.00 | 10% above | 30% |
| Simple repair of a superficial wound 2.5 cm or less, scalp, neck, body or limbs CPT 12001 RPR S/N/AX/GEN/TRNK 2.5CM/< | $499.10 | $713.00 | $1,137.00 | 37% above | 30% |
| Skin biopsy, punch, one lesion CPT 11104 PUNCH BX SKIN SINGLE LESION | $994.00 | $1,420.00 | $96.49 | 77% above | 30% |
| Spinal tap (lumbar puncture), diagnostic CPT 62270 DX LMBR SPI PNXR | $1,355.20 | $1,936.00 | $1,137.00 | 6% above | 30% |
| Stitches for a cut 2.6 to 7.5 cm (1 to 3 inches), simple repair, scalp, body, arms or legs CPT 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM | $553.70 | $791.00 | $1,137.00 | 80% above | 30% |
| Stitches for a cut on the face up to 2.5 cm (1 inch), simple repair CPT 12011 RPR F/E/E/N/L/M 2.5 CM/< | $496.30 | $709.00 | $1,137.00 | 62% above | 30% |
| Tangential (shave-style) skin biopsy, one lesion CPT 11102 BIOPSY OF RELATED SKIN GROWTH; FIRST GROWTH | $507.50 | $725.00 | $76.85 | at median | 30% |
| Upper endoscopy (EGD) with biopsy CPT 43239 EGD BIOPSY SINGLE/MULTIPLE | $777.70 | $1,111.00 | $1,412.00–$3,257.00 | 58% below | 30% |
| Upper endoscopy (EGD) with injection into the lining CPT 43236 UPPR GI SCOPE W/SUBMUC INJ | $777.70 | $1,111.00 | $1,412.00–$3,257.00 | 44% below | 30% |
| Upper endoscopy (EGD), diagnostic CPT 43235 EGD DIAGNOSTIC BRUSH WASH | $777.70 | $1,111.00 | $1,054.00–$1,801.00 | 58% below | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 REMOVAL OF SKIN AND TISSUE; 20.0 SQ CM OR LESS | $1,096.20 | $1,566.00 | $100.01 | 77% above | 30% |
| Wound debridement, skin and tissue under it, first 20 sq cm CPT 11042 DBRDMT SUBQ TIS 1ST 20SQCM/< | $1,206.10 | $1,723.00 | $100.01 | 94% above | 30% |
Doctor visits and therapy
| Procedure | Cash price | List price | Insurers pay | vs Hawaii | Off list |
|---|---|---|---|---|---|
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION OF BLOOD OR BLOOD PRODUCTS | $1,561.70 | $2,231.00 | $73.83 | 66% above | 30% |
| Blood transfusion (giving blood or blood components) CPT 36430 TRANSFUSION BLD/BLD COMPNT | $1,717.80 | $2,454.00 | $73.83 | 83% above | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 INHALATION TREATMENT FOR AIRWAY OBSTRUCTION OR SPUTUM PRODUCTION | $536.90 | $767.00 | $3,278.49–$6,615.00 | — | 30% |
| Breathing treatment (nebulizer or inhaler) for airway obstruction inpatient CPT 94640 AIRWAY INHALATION TREATMENT | $553.00 | $790.00 | $3,278.49–$6,615.00 | — | 30% |
| Chemotherapy IV infusion, first hour CPT 96413 ADMINISTRATION OF CHEMOTHERAPY INTO VEIN; 1 HOUR OR LESS | $1,274.00 | $1,820.00 | $267.46 | 74% above | 30% |
| Chemotherapy IV infusion, first hour CPT 96413 CHEMO IV INFUSION 1 HR | $1,337.70 | $1,911.00 | $267.46 | 83% above | 30% |
| Critical care, first 30 to 74 minutes CPT 99291 CRITICAL CARE FIRST HOUR | $4,480.00 | $6,400.00 | $1,137.00 | 2% above | 30% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ELECTROCARDIOGRAM TRACING | $277.90 | $397.00 | $32.46 | 11% above | 30% |
| Electrocardiogram (ECG/EKG), tracing only, the hospital charge CPT 93005 ROUTINE ELECTROCARDIOGRAM (ECG) USING AT LEAST 12 LEADS WITH TRACING | $741.30 | $1,059.00 | $32.46 | 196% above | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD SEVERITY | $464.10 | $663.00 | $1,137.00 | 19% above | 30% |
| Emergency room visit, level 1 of 5, minor problem that may not need a doctor CPT 99281 EMR DPT VST MAYX REQ PHY/QHP | $478.10 | $683.00 | $1,137.00 | 23% above | 30% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD TO MODERATE SEVERITY | $834.40 | $1,192.00 | $1,137.00 | 24% above | 30% |
| Emergency room visit, level 2 of 5, straightforward problem CPT 99282 EMERGENCY DEPT VISIT SF MDM | $859.60 | $1,228.00 | $1,137.00 | 27% above | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY | $1,629.60 | $2,328.00 | $1,137.00 | 9% above | 30% |
| Emergency room visit, level 3 of 5, low-complexity problem CPT 99283 EMERGENCY DEPT VISIT LOW MDM | $1,678.60 | $2,398.00 | $1,137.00 | 12% above | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY | $2,371.60 | $3,388.00 | $1,137.00 | 9% above | 30% |
| Emergency room visit, level 4 of 5, moderate-complexity problem CPT 99284 EMERGENCY DEPT VISIT MOD MDM | $2,443.00 | $3,490.00 | $1,137.00 | 12% above | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPARTMENT VISIT FOR LIFE THREATENING OR FUNCTIONING SEVERITY | $2,650.20 | $3,786.00 | $1,137.00 | at median | 30% |
| Emergency room visit, level 5 of 5, high-complexity problem CPT 99285 EMERGENCY DEPT VISIT HI MDM | $2,915.50 | $4,165.00 | $1,137.00 | 10% above | 30% |
| Exercise stress test, tracing only, the hospital charge CPT 93017 CARDIOVASCULAR STRESS TEST | $1,140.30 | $1,629.00 | $118.68 | 21% above | 30% |
| IV hydration (fluids through a vein), first 31 to 60 minutes CPT 96360 HYDRATION IV INFUSION INIT | $632.10 | $903.00 | $1,137.00 | 37% above | 30% |
| IV infusion of a medicine, first hour CPT 96365 INFUSION INTO A VEIN FOR THERAPY; PREVENTION; OR DIAGNOSIS; 1 HOUR OR LESS | $791.00 | $1,130.00 | $140.31 | 71% above | 30% |
| IV infusion of a medicine, first hour CPT 96365 THER/PROPH/DIAG IV INF INIT | $814.80 | $1,164.00 | $1,137.00 | 76% above | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 INJECTION OF DRUG OR SUBSTANCE UNDER SKIN OR INTO MUSCLE | $194.60 | $278.00 | $28.40 | 9% below | 30% |
| Injection under the skin or into a muscle, for treatment or testing CPT 96372 THER/PROPH/DIAG INJ SC/IM | $200.20 | $286.00 | $1,137.00 | 6% below | 30% |
| Neuromuscular re-education, 15 minutes CPT 97112 NEUROMUSCULAR REEDUCATION | $135.10 | $193.00 | $45.11 | 54% above | 30% |
| Neuromuscular re-education, 15 minutes CPT 97112 THERAPY PROCEDURE TO RE-EDUCATE BRAIN-TO-NERVE-TO-MUSCLE FUNCTION; EACH 15 MINUTES | $261.80 | $374.00 | $45.11 | 199% above | 30% |
| New patient office visit, about 30 minutes CPT 99203 OFFICE O/P NEW LOW 30 MIN | $350.70 | $501.00 | $169.15 | 32% above | 30% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE O/P NEW MOD 45 MIN | $238.70 | $341.00 | $250.59 | 15% below | 30% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE O/P NEW HI 60 MIN | $267.40 | $382.00 | $319.44 | 20% below | 30% |
| New patient office visit, straightforward problem or 15+ minutes CPT 99202 OFFICE O/P NEW SF 15 MIN | $264.60 | $378.00 | $111.10 | 32% above | 30% |
| Physical therapy evaluation, high complexity (typically about 45 minutes) CPT 97163 EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 45 MINUTES | $321.30 | $459.00 | $105.06 | 8% below | 30% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 20 MINUTES | $245.70 | $351.00 | $105.06 | 40% above | 30% |
| Physical therapy evaluation, low complexity (typically about 20 minutes) CPT 97161 PT EVAL LOW COMPLEX 20 MIN | $260.40 | $372.00 | $105.06 | 49% above | 30% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 EVALUATION FOR PHYSICAL THERAPY; TYPICALLY 30 MINUTES | $259.70 | $371.00 | $105.06 | 26% below | 30% |
| Physical therapy evaluation, moderate complexity (typically about 30 minutes) CPT 97162 PT EVAL MOD COMPLEX 30 MIN | $275.10 | $393.00 | $105.06 | 22% below | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 THERAPY PROCEDURE USING MANUAL TECHNIQUE; EACH 15 MINUTES | $146.30 | $209.00 | $40.41 | 8% below | 30% |
| Physical therapy, hands-on manual therapy (15-minute unit) CPT 97140 MANUAL THERAPY 1/> REGIONS | $150.50 | $215.00 | $40.41 | 5% below | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES | $127.40 | $182.00 | $43.60 | 46% above | 30% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPY PROCEDURE USING EXERCISE TO DEVELOP STRENGTH; ENDURANCE; RANGE OF MOTION; AND FLEXIBILITY; EACH 15 MINUTES | $371.70 | $531.00 | $43.60 | 325% above | 30% |
| Returning patient office visit, high complexity or 40+ minutes CPT 99215 OFFICE O/P EST HI 40 MIN | $371.70 | $531.00 | $225.38 | 25% above | 30% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 20-29 MINUTES | $286.30 | $409.00 | $113.91 | 8% above | 30% |
| Returning patient office visit, low complexity or 20+ minutes CPT 99213 OFFICE O/P EST LOW 20 MIN | $315.00 | $450.00 | $113.91 | 19% above | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 30-39 MINUTES | $329.00 | $470.00 | $168.35 | 32% above | 30% |
| Returning patient office visit, moderate complexity or 30+ minutes CPT 99214 OFFICE O/P EST MOD 30 MIN | $361.90 | $517.00 | $168.35 | 45% above | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT; 10-19 MINUTES | $240.10 | $343.00 | $69.58 | 16% above | 30% |
| Returning patient office visit, straightforward problem or 10+ minutes CPT 99212 OFFICE O/P EST SF 10 MIN | $263.90 | $377.00 | $69.58 | 28% above | 30% |
| Spirometry (breathing test) CPT 94010 BREATHING CAPACITY TEST | $408.80 | $584.00 | $59.00 | 38% above | 30% |
| Spirometry before and after a bronchodilator CPT 94060 EVALUATION OF WHEEZING | $258.30 | $369.00 | $101.73 | 29% below | 30% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPEUTIC ACTIVITIES | $141.40 | $202.00 | $46.34 | 62% above | 30% |
| Therapeutic activities (functional training), 15 minutes CPT 97530 THERAPY PROCEDURE USING FUNCTIONAL ACTIVITIES | $274.40 | $392.00 | $46.34 | 214% above | 30% |
| Therapeutic phlebotomy (removing blood as treatment) CPT 99195 PHLEBOTOMY | $898.80 | $1,284.00 | $60.54 | 126% above | 30% |
Vaccines
| Procedure | Cash price | List price | Insurers pay | vs Hawaii | Off list |
|---|---|---|---|---|---|
| Adjuvanted flu shot (with an immune booster ingredient), for age 65 and older CPT 90653 IIV ADJUVANT VACCINE IM | $189.70 | $271.00 | $72.19 | — | 30% |
| COVID-19 vaccine (Moderna), age 12 and older CPT 91322 SARSCOV2 VAC 50 MCG/0.5ML IM | $217.70 | $311.00 | $176.95 | at median | 30% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 Spikevax 2023-2024 Formula | $246.40 | $352.00 | $3,278.49–$6,615.00 | — | 30% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 Spikevax 2025-2026 Formula Ages 12 and up | $272.97 | $389.95 | $3,278.49–$6,615.00 | — | 30% |
| COVID-19 vaccine (Moderna), age 12 and older inpatient CPT 91322 Spikevax 2024-2025 Formula Ages 12 and up | $272.97 | $389.95 | $3,278.49–$6,615.00 | — | 30% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older CPT 91320 SARSCV2 VAC 30MCG TRS-SUC IM | $201.60 | $288.00 | $158.98 | at median | 30% |
| COVID-19 vaccine (Pfizer-BioNTech), age 12 and older inpatient CPT 91320 Comirnaty 2023-2024 Age 12 and older | $231.00 | $330.00 | $3,278.49–$6,615.00 | — | 30% |
| Chickenpox (varicella) vaccine, live (Varivax) CPT 90716 VAR VACCINE LIVE SUBQ | $325.50 | $465.00 | $240.82 | 29% above | 30% |
| Chickenpox (varicella) vaccine, live (Varivax) inpatient CPT 90716 Varivax | $368.38 | $526.26 | $3,278.49–$6,615.00 | — | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older CPT 90656 IIV3 VACC NO PRSV 0.5 ML IM | $49.70 | $71.00 | $23.33 | 58% above | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Fluarix 2025-2026 Formula | $38.00 | $54.29 | $3,278.49–$6,615.00 | — | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 FluLaval 2025-2026 Formula | $38.00 | $54.29 | $3,278.49–$6,615.00 | — | 30% |
| Flu shot, standard dose, preservative-free, for age 6 months and older inpatient CPT 90656 Fluzone 2025-2026 Formula PFS | $38.75 | $55.36 | $3,278.49–$6,615.00 | — | 30% |
| HPV vaccine, 9-valent (Gardasil 9) CPT 90651 9VHPV VACCINE 2/3 DOSE IM | $527.80 | $754.00 | $397.31 | 24% above | 30% |
| HPV vaccine, 9-valent (Gardasil 9) inpatient CPT 90651 Gardasil 9 | $632.06 | $902.94 | $3,278.49–$6,615.00 | — | 30% |
| Hepatitis A and B combination vaccine, adult (Twinrix) inpatient CPT 90636 Twinrix | $252.05 | $360.07 | $3,278.49–$6,615.00 | — | 30% |
| Hepatitis A vaccine, adult dose CPT 90632 Vaqta | $207.20 | $296.00 | $108.99 | 42% above | 30% |
| Hepatitis A vaccine, adult dose CPT 90632 HEPA VACCINE ADULT IM | $214.90 | $307.00 | $108.99 | 47% above | 30% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 Vaqta | $159.75 | $228.21 | $3,278.49–$6,615.00 | — | 30% |
| Hepatitis A vaccine, adult dose inpatient CPT 90632 Havrix | $164.40 | $234.86 | $3,278.49–$6,615.00 | — | 30% |
| Hepatitis B vaccine, adult dose (3-dose schedule) CPT 90746 HEPB VACCINE 3 DOSE ADULT IM | $168.70 | $241.00 | $92.21 | 37% above | 30% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 HEPB VACCINE 3 DOSE ADULT IM | $137.57 | $196.53 | $3,278.49–$6,615.00 | — | 30% |
| Hepatitis B vaccine, adult dose (3-dose schedule) inpatient CPT 90746 Engerix-B | $137.62 | $196.60 | $3,278.49–$6,615.00 | — | 30% |
| High-dose flu shot, preservative-free, mainly for age 65 and older inpatient CPT 90662 Fluzone High-Dose 2025-2026 Formula | $164.55 | $235.07 | $3,278.49–$6,615.00 | — | 30% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 M-M-R II | $181.30 | $259.00 | $127.35 | 16% above | 30% |
| MMR vaccine (measles, mumps and rubella), live CPT 90707 MMR VACCINE SC | $188.30 | $269.00 | $127.35 | 21% above | 30% |
| MMR vaccine (measles, mumps and rubella), live inpatient CPT 90707 M-M-R II | $184.30 | $263.29 | $3,278.49–$6,615.00 | — | 30% |
| Meningococcal ACWY (MenACWY) vaccine CPT 90734 MENACWYD/MENACWYCRM VACC IM | $729.40 | $1,042.00 | $205.47 | 163% above | 30% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Menactra | $284.90 | $407.00 | $3,278.49–$6,615.00 | — | 30% |
| Meningococcal ACWY (MenACWY) vaccine inpatient CPT 90734 Menveo | $319.55 | $456.50 | $3,278.49–$6,615.00 | — | 30% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule CPT 90620 MENB-4C VACCINE IM | $893.20 | $1,276.00 | $291.97 | 131% above | 30% |
| Meningococcal B vaccine (Bexsero), 2-dose schedule inpatient CPT 90620 Bexsero | $455.03 | $650.04 | $3,278.49–$6,615.00 | — | 30% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) CPT 90677 PCV20 VACCINE IM | $702.10 | $1,003.00 | $350.91 | at median | 30% |
| Pneumonia vaccine, 20-valent conjugate (Prevnar 20) inpatient CPT 90677 Prevnar 20 | $527.17 | $753.10 | $3,278.49–$6,615.00 | — | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) CPT 90732 PPSV23 VACC 2 YRS+ SUBQ/IM | $235.20 | $336.00 | $161.86 | 20% above | 30% |
| Pneumonia vaccine, 23-valent polysaccharide (Pneumovax 23) inpatient CPT 90732 Pneumovax 23 | $225.39 | $321.98 | $3,278.49–$6,615.00 | — | 30% |
| RSV antibody shot for infants, seasonal dose (0.5 mL) CPT 90380 RSV MONOC ANTB SEASN .5ML IM | $863.10 | $1,233.00 | $718.50 | 5% below | 30% |
| Rabies vaccine, one dose inpatient CPT 90675 RabAvert | $836.63 | $1,195.18 | $3,278.49–$6,615.00 | — | 30% |
| Rabies vaccine, one dose inpatient CPT 90675 RABIES VACCINE IM | $836.63 | $1,195.18 | $3,278.49–$6,615.00 | — | 30% |
| Rabies vaccine, one dose inpatient CPT 90675 Imovax Rabies | $868.48 | $1,240.69 | $3,278.49–$6,615.00 | — | 30% |
| Shingles vaccine (Shingrix), recombinant, one dose CPT 90750 HZV VACC RECOMBINANT IM | $758.80 | $1,084.00 | $253.54 | — | 30% |
| Shingles vaccine (Shingrix), recombinant, one dose inpatient CPT 90750 Shingrix | $414.86 | $592.65 | $3,278.49–$6,615.00 | — | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 TD VACC NO PRESV 7 YRS+ IM | $68.60 | $98.00 | $38.69 | 19% above | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older CPT 90714 Tenivac | $102.69 | $146.70 | $38.69 | 78% above | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 TDVAX | $53.87 | $76.96 | $3,278.49–$6,615.00 | — | 30% |
| Td vaccine (tetanus and diphtheria booster), age 7 and older inpatient CPT 90714 Tenivac | $78.44 | $112.06 | $3,278.49–$6,615.00 | — | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 TDAP VACCINE 7 YRS/> IM | $113.40 | $162.00 | $71.94 | 50% above | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older CPT 90715 Boostrix | $114.86 | $164.09 | $71.94 | 51% above | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Boostrix | $89.51 | $127.87 | $3,278.49–$6,615.00 | — | 30% |
| Tdap vaccine (tetanus, diphtheria and whooping cough), age 7 and older inpatient CPT 90715 Adacel | $90.38 | $129.12 | $3,278.49–$6,615.00 | — | 30% |
| Typhoid vaccine, injectable (Vi polysaccharide) inpatient CPT 90691 Typhim Vi | $296.26 | $423.23 | $3,278.49–$6,615.00 | — | 30% |
| Vaccine administration fee (giving the shot), first vaccine of the visit CPT 90471 IMMUNIZATION ADMIN | $177.10 | $253.00 | $28.40 | 34% above | 30% |
| Vaccine administration fee, each additional vaccine at the same visit CPT 90472 IMMUNIZATION ADMIN EACH ADD | $51.80 | $74.00 | $14.20 | at median | 30% |
Source file: https://www.queens.org/wp-content/uploads/990251372_molokai-general-hospital_standardcharges-3.csv