CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Kona Community Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $522
Cash Discount Price: $1,797
vs. Medicare Baseline: 1.46x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Kona Community Hospital is $522. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,797. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 1.46x the Medicare baseline. Located in 79-1019 Haukapila Street, Kealakekua, HI.

Cash / Self-Pay

$1,797

Average discount available for prompt cash payment at this facility.

Insurance Median

$522

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)

Cash / Self-Pay: $1,797 (504%)

Insurance Median: $522 (146%)

Cash: $1,797 (504% of Medicare)

Ins. Median: $522 (146% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $356.43 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Alohacare	$412 - $481	116%
Ohana Health Plan	$412 - $453	116%
Hawaii Medical Service Association	$412 - $924	116%
UnitedHealthcare	$412 - $880	116%
Kaiser Permanente	$412 - $1,991	116%
Humana	$412 - $481	116%
Hawaii Western Management Group	$412	116%
Devoted Health	$453	127%
Kaiser	$481	135%
Hmsa	$481 - $1,811	135%
Ohana	$481 - $530	135%
Hma	$750	210%
Uha	$1,081	303%
University Health Alliance	$1,297	364%
Hmaa	$2,020	567%
Health Management Network	$2,686	754%
Mdx Hawaii	$3,065	860%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $1,797.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70553.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Kona Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 70553.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.