CMS Price Transparency Data

Total hip replacement

Facility: Adventist Health Castle

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $1,486
Cash Discount Price: $755
vs. Medicare Baseline: 0.11x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Adventist Health Castle is $1,486. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $755. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.11x the Medicare baseline. Located in 640 Ulukahiki St, Kailua, HI.

Cash / Self-Pay

$755

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,486

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$13,116.76

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $13,116.76 (100%)

Cash / Self-Pay: $755 (6%)

Insurance Median: $1,486 (11%)

Cash: $755 (6% of Medicare)

Ins. Median: $1,486 (11% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $13,116.76 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 Quest Mcaid - All Other Plans	$1,158	9%
Kfh Mcr Adv	$1,158	9%
Medicare (plans)	$1,158	9%
UnitedHealthcare	$1,158	9%
Devoted Hlth Mcr Adv - All Plans	$1,193	9%
Alohacare Mcr Adv Profee Only	$1,216	9%
First Health Ppo - All Plans	$1,425 - $3,008	11%
Multiplan Hmn - All Plans	$1,486	11%
Medicaid / KanCare	$1,516 - $3,200	12%
Ohana Health Plan - All Plans	$1,516 - $3,200	12%
Mdx Hawaii Ppo - All Plans	$1,596	12%
Hwmg/Hmaa - All Plans	$1,672	13%
State Of Hi Nonprofit - All Plans	$2,606	20%

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 $755.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 27130.

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 CPT code 27130.
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.