How many shoppable procedure prices are published for Kohala Hospital?

Kohala Hospital in Kapaau, HI currently has 126 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do Kohala Hospital's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, Kohala Hospital's median negotiated commercial rate is 0.8× the regionally adjusted fair BaseRate benchmark.

Hospital Profile Critical Access Hospital Government - State 25 Beds · rural Updated: 6/28/2024

Kohala Hospital

54-383 Hospital Road, Kapaau, HI 96755 · 126 Priced Procedures

CMS Overall Rating No CMS Rating

Good Deal · Below Fair Market

0.85×vs. Fair Market Price

Typical commercial prices here are 15% below the fair benchmark (0.85×) after accounting for local nurse/doctor wages and patient complexity.

82/100 · Corroborated

82/100Self-Pay Cash Beats Insurance 26% of the Time

File Completeness61

Price Logic94

Peer Alignment71

Clean Billing84

Real Cash Discount100

Regional Value Leader

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

Behavioral Pricing FingerprintLow Shoppable & Low Captive Rates

Uniform Value Leader · Low-Cost Across Departments

Kohala Hospital maintains low, disciplined commercial pricing across both routine shoppable procedures (0.9× Medicare, p50 0.91× Fair BaseRate) and emergency/ancillary services (1.0× Medicare, p75 0.97× Fair BaseRate). Both insured and self-pay patients benefit from below-benchmark rates across departments.

#3 of 20 in HI · 10th State Percentile#423 of 3,385 in U.S. · 12th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Elective shoppable care is priced 15% below peer Fair BaseRate (0.85×)
Self-pay cash beats commercial insurance on 26% of shoppable procedures (99/100 Cash Honesty)
CMS clinical safety score (85/100 safety score) with 72% patient recommendation
Binding Good Faith Estimate rights under 45 CFR § 149.610 protect self-pay patients before scheduling

Watchout

Where You Can Get Burned (Markup Traps)

Outpatient surgery & OR suites carry a 1.1× markup over Medicare rates
Captive ER (1.3×) & laboratory (1.9×) services average 1.11× higher multiples than routine shoppable care (0.9×)
Specialty infusion drugs (J-codes) average 4.1× Medicare — verify per-unit billing on itemized statements
Consolidated metro market (HHI 4,475) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))

Front-Door ShoppableElective / Imaging

0.9× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER1.11× Divergence

1.0× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+7% Upper Tail

Q25 0.52× · Q50 0.91× · Q75 0.97×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.

Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×

Front-Door Shoppable CareFront-Door Shoppable

0.9× MedicareGood

Outpatient Surgery & ORBack-Door Captive

1.1× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

0.7× MedicareGood

Back-Door Captive ER VisitsBack-Door Captive

1.3× MedicareGood

Inpatient Lab & PathologyBack-Door Captive

1.9× MedicareGood

Specialty & Infusion Drugs (J-Codes)Back-Door Captive

4.1× MedicareElevated

Self-Pay Cash Honesty & 501(r)Integrity & Outcomes

26% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

3 CMS · 85/100Good

Procedure Prices at Kohala Hospital

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 126 published procedures.

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Audit a Bill & 501(r) Cap ↓

Procedure & Billing Code	Self-Pay Cash	This Hospital	Fair BaseRate	vs. Fair
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	—	$28,814	$19,087	1.5×
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	—	$19,629	$19,432	1.0×
Total hip replacement CPT Code: `27130`	—	$14,613	$13,413	1.1×
Total knee replacement CPT Code: `27447`	—	$14,613	$13,523	1.1×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	—	$10,275	$8,223	1.2×
Gallbladder removal (laparoscopic) CPT Code: `47562`	—	$5,837	$6,109	1.0×
Inguinal hernia repair CPT Code: `49505`	—	$3,967	$3,629	unverified
Breast lump removal CPT Code: `19120`	—	$3,850	$3,875	unverified
Bunion correction surgery CPT Code: `28296`	—	$3,334	$3,446	1.0×
Knee arthroscopy with meniscus repair CPT Code: `29881`	—	$3,334	$3,372	unverified
Cataract surgery with lens implant CPT Code: `66984`	—	$2,418	$2,540	1.0×
C-section delivery (full package) CPT Code: `59510`	—	$1,500	$2,975	0.5×
Trauma team activation HCPCS Code: `G0390`	—	$1,290	$1,453	0.9×
Colonoscopy with biopsy CPT Code: `45380`	—	$1,213	$1,256	1.0×
Vaginal delivery (full package) CPT Code: `59400`	—	$1,114	$2,680	0.4×
Sleep study (overnight, in lab) CPT Code: `95810`	—	$1,046	$1,021	1.0×
Colonoscopy (diagnostic) CPT Code: `45378`	—	$931	$981	0.9×
Upper endoscopy with biopsy CPT Code: `43239`	—	$925	$987	0.9×
Injection procedure for pain management HCPCS Code: `G0260`	—	$722	$855	0.8×
Echocardiogram (heart ultrasound) CPT Code: `93306`	—	$563	$583	1.0×
Hospital observation (per hour) HCPCS Code: `G0378`	—	$549	$86	unverified
Blood transfusion CPT Code: `36430`	$798	$457	$498	0.9×
Psychological testing by technician CPT Code: `96138`	—	$423	$395	1.1×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$530	$413	$448	0.9×
MRI, brain (with and without contrast) CPT Code: `70553`	—	$413	$511	0.8×
Neurobehavioral status check CPT Code: `96116`	—	$314	$231	1.4×
Rabies immune globulin HCPCS Code: `90375`	—	$312	$322	1.0×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$576	$262	$303	0.9×
MRI, lower back (no contrast) CPT Code: `72148`	—	$262	$338	0.8×
MRI, brain (no contrast) CPT Code: `70551`	—	$262	$343	0.8×
MRI, knee or other leg joint CPT Code: `73721`	—	$262	$369	0.7×
CT scan, head (with contrast) CPT Code: `70460`	$878	$202	$242	0.8×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$549	$225	$272	0.8×
CT scan, head (with and without contrast) CPT Code: `70470`	$146	$202	$258	0.8×
Breathing treatment (nebulizer) CPT Code: `94640`	$169	$214	$201	unverified
Psychotherapy session (45 minutes) CPT Code: `90834`	$199	$163	$166	1.0×
Hepatitis B immune globulin HCPCS Code: `90371`	—	$143	$151	0.9×
Family therapy session CPT Code: `90847`	—	$163	$173	0.9×
Psychotherapy session (60 minutes) CPT Code: `90837`	$294	$163	$181	0.9×
Psychiatric evaluation (first visit) CPT Code: `90791`	$325	$163	$185	0.9×
Psychological testing evaluation CPT Code: `96136`	—	$130	$128	1.0×
New patient office visit (30-44 min) CPT Code: `99203`	$129	$129	$110	unverified
Office visit, established patient (30-39 min) CPT Code: `99214`	$133	$133	$123	unverified
Orthotic fitting and training CPT Code: `97760`	$95	$95	$51	1.9×
Screening mammogram (both breasts) CPT Code: `77067`	$218	$107	$123	0.9×
Ultrasound, abdomen (limited) CPT Code: `76705`	$387	$103	$126	0.8×
Diagnostic mammogram (both breasts) CPT Code: `77066`	—	$113	$148	0.8×
CT scan, head (no contrast) CPT Code: `70450`	$492	$120	$160	0.8×
CT scan, pelvis CPT Code: `72192`	$447	$120	$163	0.7×
CT scan, sinuses CPT Code: `70486`	$684	$120	$166	0.7×
CT scan, chest (no contrast) CPT Code: `71250`	$684	$120	$167	0.7×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$684	$120	$168	0.7×
CT scan, neck (cervical spine) CPT Code: `72125`	$406	$120	$169	0.7×
Ultrasound, thyroid and neck CPT Code: `76536`	$387	$120	$132	unverified
Ultrasound, abdomen (complete) CPT Code: `76700`	$237	$120	$134	unverified
Ultrasound, pelvis CPT Code: `76856`	$351	$120	$130	unverified
Group therapy session CPT Code: `90853`	—	$85	$100	0.8×
Typhoid vaccine HCPCS Code: `90675`	—	$398	$347	1.1×
Drug screening test HCPCS Code: `G0480`	—	$114	$116	1.0×
Colorectal cancer screening HCPCS Code: `G0010`	—	$47	$49	1.0×
X-ray, hip CPT Code: `73502`	$209	$59	$93	0.6×
X-ray, lower back CPT Code: `72110`	$326	$57	$112	0.5×
Care planning with family CPT Code: `90887`	—	$53	$107	0.5×
Pneumococcal vaccine HCPCS Code: `90732`	$129	$59	$140	0.4×
Varicella (chickenpox) vaccine HCPCS Code: `90716`	$167	$75	$203	0.4×
Electrocardiogram (ECG/EKG) CPT Code: `93000`	$31	$29	$25	1.2×
Blood test, vitamin D CPT Code: `82306`	$89	$30	$31	1.0×
Colorectal cancer screening (alternative) HCPCS Code: `G0145`	—	$26	$27	1.0×
Flu vaccine injection HCPCS Code: `G0008`	—	$47	$48	unverified
Pneumonia vaccine injection HCPCS Code: `G0009`	—	$47	$49	unverified
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$64	$19	$20	0.9×
Electrical stimulation therapy HCPCS Code: `G0283`	—	$10	$14	0.7×
Physical therapy (manual therapy) CPT Code: `97140`	$95	$21	$34	0.6×
Physical therapy (functional capacity test) CPT Code: `97750`	—	$20	$38	0.5×
X-ray, neck (cervical spine) CPT Code: `72040`	$207	$45	$93	0.5×
Physical therapy (gait training) CPT Code: `97116`	$81	$17	$33	0.5×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$100	$19	$38	0.5×
Speech therapy (language evaluation) CPT Code: `92507`	$179	$40	$86	0.5×
X-ray, ankle CPT Code: `73610`	$202	$42	$93	0.5×
X-ray, hand CPT Code: `73130`	$202	$41	$93	0.4×
Blood test, ferritin (iron stores) CPT Code: `82728`	$84	$14	$14	1.0×
X-ray, shoulder CPT Code: `73030`	$196	$39	$92	0.4×
X-ray, foot CPT Code: `73630`	$202	$39	$92	0.4×
X-ray, chest (two views) CPT Code: `71046`	$214	$39	$93	0.4×
Office visit, established patient (20-29 min) CPT Code: `99213`	—	$36	$87	0.4×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	—	$44	$111	0.4×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$89	$11	$11	1.0×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$17	$3	$3	1.0×
Blood test, calcium CPT Code: `82310`	$50	$5	$5	1.0×
Blood test, creatinine (kidney) CPT Code: `82565`	$28	$5	$5	1.0×
Blood test, glucose (blood sugar) CPT Code: `82947`	$30	$4	$4	1.0×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$86	$10	$10	1.0×
Blood test, lipase CPT Code: `83690`	$38	$7	$7	1.0×
Blood test, magnesium CPT Code: `83735`	$70	$7	$7	1.0×
Blood test, potassium CPT Code: `84132`	$40	$5	$5	1.0×
Blood test, sodium CPT Code: `84295`	$36	$5	$5	1.0×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$40	$4	$4	1.0×
Blood test, hemoglobin CPT Code: `85018`	$8	$3	$3	1.0×
Blood test, complete blood count (CBC) CPT Code: `85025`	$103	$8	$8	1.0×
Blood test, clotting time (PTT) CPT Code: `85730`	$49	$6	$6	1.0×
Culture, bacterial CPT Code: `87070`	$70	$9	$9	1.0×
Blood test, PSA (prostate screen) CPT Code: `84153`	$47	$18	$19	0.9×
Blood test, thyroid (TSH) CPT Code: `84443`	$80	$17	$18	0.9×
Blood test, vitamin B12 CPT Code: `82607`	$70	$15	$16	0.9×
Hepatitis C antibody test CPT Code: `86803`	$114	$14	$15	0.9×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$168	$13	$14	0.9×
Culture, blood CPT Code: `87040`	$88	$10	$11	0.9×
Blood test, basic metabolic panel CPT Code: `80048`	$82	$8	$9	0.9×
Blood test, liver function panel CPT Code: `80076`	$85	$8	$9	0.9×
X-ray, chest (single view) CPT Code: `71045`	$196	$32	$92	0.3×
X-ray, pelvis CPT Code: `72170`	$207	$32	$110	0.3×
Blood test, amylase CPT Code: `82150`	$61	$6	$7	0.9×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$46	$4	$5	0.8×
Speech therapy (group session) CPT Code: `92508`	—	$20	$27	0.7×
Extended office visit (prolonged) HCPCS Code: `G2212`	—	$23	$33	0.7×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$95	$18	$35	0.5×
Diagnostic procedure preparation HCPCS Code: `G0279`	—	$18	$35	0.5×
Blood antibody screen CPT Code: `86850`	$78	$23	$46	0.5×
Occupational therapy (self-care training) CPT Code: `97535`	$98	$19	$38	0.5×
DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: `90700`	$83	$19	$39	0.5×
Flu vaccine (high dose) HCPCS Code: `90656`	—	$12	$25	0.5×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$95	$18	$40	0.5×
Hepatitis B vaccine HCPCS Code: `90744`	$25	$15	$37	0.4×
Prosthetic fitting and training CPT Code: `97761`	—	$18	$45	0.4×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$60	$19	$56	0.3×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$133	$19	$64	0.3×

Showing top 25 high-impact procedures of 126 total

Inline Bill X-Ray & 501(r) Calculator For-Profit Facility · Cash & Fair BaseRate Audit

Audit a Bill or Quote at Kohala Hospital (Zero PHI Required)

CMS CCN: 121302

CPT 871

Select Procedure to Audit:

Fair BaseRate™ $19,087

Medicare Rate $14,117

Self-Pay Cash Request Quote

Insurer Median $28,814

1. Amount on Your Bill or Quote ($) Pre-filled with Kohala Hospital’s charged/list benchmark

2. Household Annual Income ($) Screened against 2026 HHS Federal Poverty Guidelines

3. Household Size (1–8) 2026 FPL: $15,650 + $5,500 per additional person

Step 1 · 501(r) Charity Care Check 274% of 2026 FPL

Above Standard 400% FPL Financial-Assistance Ceiling

At 274% FPL, you exceed the standard 400% FPL tier, though medical-hardship caps (when bills exceed 10% of annual income) may still apply.

Step 2 · Cash vs. Insurance Arbitrage Request Prompt-Pay Quote

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask Kohala Hospital's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.

Step 3 · Fair BaseRate Target +$50,067 Above Fair BaseRate

Negotiate Toward $19,087 Fair BaseRate ($14,117 Medicare)

Your bill ($69,154) is $50,067 above the denoised Fair BaseRate ($19,087) and 4.9× the $14,117 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.

IRS Form 990 Schedule H & 26 U.S.C. § 501(r) For-Profit / Non-501(c)(3)

Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)

Public IRS & CMS ownership records classify Kohala Hospital as a non-501(c)(3) facility. Federal 26 U.S.C. § 501(r) statutory charity-care caps apply specifically to tax-exempt nonprofit hospitals, though state hospital fair-pricing statutes and prompt-pay self-pay discounts may still apply.

Screen your household size, income, and itemized CPT codes against 2026 HHS Federal Poverty Guidelines: Calculate Your 501(r) Cap Above ↑

CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

Safety Composite85/100

Median ER Wait82 min

Left ER Before Seen1%

CMS Price Transparency Administrative Enforcement Log

Factual public administrative actions published by the Centers for Medicare & Medicaid Services regarding 45 CFR § 180 compliance at Kohala Hospital. Prior administrative notices do not necessarily reflect current compliance status.

2023-04-14·administrative_or_closure
Met Requirements
Recorded

Source: CMS Hospital Care Compare. Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Regional Quality & Price Benchmark

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Kohala Hospital.

Price Index: 1.00× regional baseline

Quality: 56/100 CMS composite

Notable Payer Contract Outliers (SVD Matrix Anomalies)

Mdx

+127.2%

Median Household Income$77,215U.S. Census ACS

Local Uninsured Share4.2%Regional ACS estimate

200% FPL (1 Person)$36,720Common free-care ceiling

400% FPL (Family of 4)$147,920Common AGB cap ceiling

45 CFR § 180 Primary-Source Lineage & Federal Verification VeriRate 82/100 · Corroborated CMS CCN 121302

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

MRF Portal Indexed (CMS_45_CFR_180_FILING.json) Verify on CMS Medicare.gov (CCN 121302) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileCMS_45_CFR_180_FILING.json

Publication / Vintage6/28/2024

Validated Rate Rows2,390 (CMS v2.0.0)

File Integrity DigestVerified · CCN 121302

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy