| Hospital | Address | Code | Price | Last Updated |
|---|---|---|---|---|
| Hilo Medical Center | 1190 Waianuenue Ave, Hilo | G0109 | $15 [source] | 3 years ago |
| Kona Community Hospital | 79-1019 Haukapila St, Kealakekua | G0109 | $15 [source] | 3 years ago |
| Hale Ho'ola Hamakua | 100 Keokea Pl, Kula | G0109 | $20 [source] | 3 years ago |
| Kau Hospital | 1 Kamani Street, Pahala | G0109 | $20 [source] | 3 years ago |
| Kohala Hospital | 54 383 Hospital Road, Kapaau | G0109 | $20 [source] | 3 years ago |
| The Queen's Medical Center - West O'ahu | 1301 Punchbowl St, Honolulu | G0109 | $72 [source] | 3 years ago |
| The Queen's Medical Center | 4800 Kawaihau Rd, Kapaa | G0109 | $72 [source] | 3 years ago |
| North Hawaii Community Hospital | 67-1125 Mamalahoa Hwy, Kamuela | G0109 | $95 [source] | 3 years ago |