Home › Hospitals › Molokai General Hospital Posts prices for 32 of the 66 common shoppable procedures we track. Price file retrieved 2026-08-28.
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Procedure Cash price Gross charge × Medicare
Upper GI endoscopy (EGD), diagnostic (43235) $777.70
$1,111
0.7×
Upper GI endoscopy (EGD) with biopsy (43239) $777.70
$1,111
0.7×
Diagnostic colonoscopy (45378) $756.70
$1,081
0.7×
Colonoscopy with biopsy (45380) $978.60
$1,398
0.7×
Colonoscopy with lesion removal (45385) $978.60
$1,398
0.7×
CT head/brain without contrast (70450) $1,445.15
$2,064.50
11.7×
X-ray lower spine, 4+ views (72110) $483
$690
3.9×
CT pelvis with contrast (72193) $1,810.20
$2,586
8.7×
CT abdomen and pelvis with contrast (74177) $2,865.80
$4,094
7.0×
Ultrasound, abdomen complete (76700) $741.65
$1,059.50
6.0×
Ultrasound, pregnant uterus (≥14 weeks) (76805) $596.75
$852.50
4.8×
Ultrasound, transvaginal (76830) $506.80
$724
4.1×
Mammography, one breast (diagnostic) (77065) $283.50
$405
3.3×
Mammography, both breasts (diagnostic) (77066) $415.10
$593
3.8×
Mammography, screening (bilateral) (77067) $283.50
$405
3.1×
Basic metabolic panel (80048) $133.35
$190.50
15.8×
Comprehensive metabolic panel (80053) $105
$150
9.9×
Lipid panel (80061) $104.65
$149.50
7.8×
Renal function panel (80069) $84
$120
9.7×
Hepatic function panel (80076) $122.15
$174.50
15.0×
Urinalysis, non-automated, with microscopy (81000) $28.70
$41
7.1×
Urinalysis, non-automated, without microscopy (81002) $18.90
$27
5.4×
PSA, total (84153) $122.50
$175
6.7×
Thyroid stimulating hormone (TSH) (84443) $169.75
$242.50
10.1×
CBC with automated differential (85025) $94.85
$135.50
12.2×
CBC, automated (85027) $107.10
$153
16.6×
Prothrombin time (PT) (85610) $52.50
$75
12.2×
Partial thromboplastin time (PTT) (85730) $61.60
$88
10.2×
Physical therapy, therapeutic exercise (per 15 min) (97110) $249.55
$356.50
8.6×
Office visit, new patient (low complexity, ~30 min) (99203) $350.70
$501
2.2×
Office visit, new patient (moderate complexity, ~45 min) (99204) $238.70
$341
1.5×
Office visit, new patient (high complexity, ~60 min) (99205) $267.40
$382
1.7×
As a Critical Access Hospital, Medicare pays this facility about 101% of its own costs. The × Medicare column compares the cash price against that cost-based benchmark, not a standard rate.
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