CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Adventist Health St Helena

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $54,847
Cash Discount Price: $22,945
vs. Medicare Baseline: 3.89x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Adventist Health St Helena is $54,847. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $22,945. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 3.89x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$22,945

Average discount available for prompt cash payment at this facility.

Insurance Median

$54,847

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14,116.91

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14,116.91 (100%)

Cash / Self-Pay: $22,945 (163%)

Insurance Median: $54,847 (389%)

Cash: $22,945 (163% of Medicare)

Ins. Median: $54,847 (389% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14,116.91 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 389% of the Medicare baseline (a markup of 289%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Blue Shield Bh Mcr Adv	$19,943	141%
Blue Shield Mcr Adv	$19,943	141%
Tricare	$19,943	141%
UnitedHealthcare	$19,943 - $93,782	141%
Va Mcr - All Other Plans	$19,943	141%
Magellan Mcare Ip Only	$21,262	151%
Va Medi-Cal	$23,021	163%
Phcs-All Plans	$25,438	180%
Interplan-All Plans	$28,062	199%
Ah Employee Health Plan - All Plans	$35,897	254%
Healthnet-All Plans	$41,854	296%
Blue Shield Epn-All Other Plans	$44,193	313%
Blue Shield Non-Epn	$45,184	320%
Blue Cross Blue Shield	$48,995 - $66,210	347%
Aetna	$54,615	387%
Western Growers-All Plans	$55,078	390%
Kaiser Mcr Adv	$74,243	526%
Kaiser-All Other Plans	$74,243	526%
Coventry/First Health-All Plans	$91,779	650%
Beech Street-All Plans	$107,075	758%
Choicecare-All Plans	$107,075	758%
Cigna	$107,075	758%
Health Management Network-All Plans	$130,020	921%
Galaxy Network-All Plans	$137,668	975%
Three Rivers-All Plans	$137,668	975%

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 $22,945.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 871.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health St Helena is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 871.
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.