CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Grossmont Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $89,864
Cash Discount Price: $105,640
vs. Medicare Baseline: 6.37x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Grossmont Hospital is $89,864. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $105,640. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 6.37x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$105,640

Average discount available for prompt cash payment at this facility.

Insurance Median

$89,864

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: $105,640 (748%)

Insurance Median: $89,864 (637%)

Cash: $105,640 (748% of Medicare)

Ins. Median: $89,864 (637% 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 637% of the Medicare baseline (a markup of 537%). 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
Medicare (plans)	$21,128	150%
Cigna	$39,439	279%
UnitedHealthcare	$42,960	304%
Managed Health Network	$55,651	394%
Allianz Global Assistance	$67,483	478%
Blue Cross Blue Shield	$67,483 - $97,189	478%
Aetna	$69,159 - $108,457	490%
Multiplan	$70,427	499%
Epic Americas	$97,189	688%
Health Net	$98,597	698%
Molina	$98,597	698%
Kaiser	$105,640	748%
Indian Health Council	$112,683	798%
Interplan	$112,683	798%

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 $105,640.
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 Grossmont Hospital 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.