CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Adventist Health Castle

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 392
Insurance Median: $11,070
Cash Discount Price: $7,085
vs. Medicare Baseline: 1.95x Medicare

The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Adventist Health Castle is $11,070. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,085. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 1.95x the Medicare baseline. Located in 640 Ulukahiki St, Kailua, HI.

Cash / Self-Pay

$7,085

Average discount available for prompt cash payment at this facility.

Insurance Median

$11,070

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$5,675.87

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $5,675.87 (100%)

Cash / Self-Pay: $7,085 (125%)

Insurance Median: $11,070 (195%)

Cash: $7,085 (125% of Medicare)

Ins. Median: $11,070 (195% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $5,675.87 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
Hmsa Quest Abd	$2,070	36%
Hmsa Quest Non-Abd	$2,070	36%
Medicaid / KanCare	$6,177	109%
Ohana Health Plan - All Plans	$6,177	109%
UnitedHealthcare	$6,177	109%
Kfh Mcr Adv	$7,499	132%
Medicare (plans)	$7,499	132%
Devoted Hlth Mcr Adv - All Plans	$7,874	139%
Kfh - All Other Plans	$8,871	156%
Hwmg/Hmaa - All Plans	$9,846	173%
Alohacare Quest Mcaid - All Other Plans	$11,070	195%
Pacific Admin Ppo - All Plans	$11,402	201%
State Of Hi Nonprofit - All Plans	$12,373	218%
Mdx Hawaii Ppo - All Plans	$13,041	230%
Magellan Bh Ip Only - All Plans	$13,284	234%
Health Alliance - All Plans	$13,915	245%
Multiplan Hmn - All Plans	$13,915	245%
Hmsa Hmo	$14,329	252%
Hmsa Ppo - All Other Plans	$14,329	252%
Uni Health Alliance - All Plans	$18,092	319%
First Health Ppo - All Plans	$20,812	367%

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 $7,085.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 392.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health Castle is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 392.
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.