CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Paradise Valley Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 871
  • Insurance Median: $19,769
  • Cash Discount Price: $19,768
  • vs. Medicare Baseline: 1.40x Medicare
The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Paradise Valley Hospital is $19,769. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $19,768. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.40x the Medicare baseline. Located in 2400 East 4Th St, National City, CA.
Cash / Self-Pay
$19,768

Average discount available for prompt cash payment at this facility.

Insurance Median
$19,769

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: $19,768 (140%)
Insurance Median: $19,769 (140%)
Cash: $19,768 (140% of Medicare)
Ins. Median: $19,769 (140% 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Tricare $19,665 - $19,769 139%
Blue Shield Of Ca, Va $19,769 140%
Ca Foundation For Medical Care $19,769 140%
Central Health $19,769 140%
Choice Physicians Network $19,769 140%
Clever Care Of Golden State, Inc $19,769 140%
Community Health Group $19,769 140%
Health Excel Ins $19,769 140%
Health Net Of Ca $19,769 - $35,821 140%
Heritage Provider Netwrok $19,769 - $25,699 140%
Managed Health Network $19,769 140%
Medicare (plans) $19,769 140%
Molina $19,769 140%
Renal Payer Solutions $19,769 140%
UnitedHealthcare $19,769 140%
Usa Senior Care Network $19,769 140%
Verda Health Plan $19,769 140%
Brand New Day $19,966 141%
Imperial Health Plan Of Ca $20,955 148%
Health Net Federal Service (Cdcr) $24,711 175%
Employer Direct Healthcare $25,699 182%
Integrated Medical Solutions $25,699 182%
Ca Dept Of Correction & Rehab $27,676 196%
Naphcare $30,642 - $39,538 217%
National Healthcare Solutions, Inc (Nhsi) $31,630 224%
Scripps Health $33,607 238%
Aetna $34,979 248%
Worker Comp $36,061 255%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 2400 East 4Th St, National City, CA 91950
  • CMS Rating: ★★★☆☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals