CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Adventist Health and Rideout

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $88,942
Cash Discount Price: $27,677
vs. Medicare Baseline: 6.30x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Adventist Health and Rideout is $88,942. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $27,677. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 6.30x the Medicare baseline. Located in 726 4Th St, Marysville, CA.

Cash / Self-Pay

$27,677

Average discount available for prompt cash payment at this facility.

Insurance Median

$88,942

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: $27,677 (196%)

Insurance Median: $88,942 (630%)

Cash: $27,677 (196% of Medicare)

Ins. Median: $88,942 (630% 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 630% of the Medicare baseline (a markup of 530%). 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
Healthnet Mcal	$14,740	104%
Kaiser Mcr Adv	$18,662	132%
Tricare	$18,662	132%
UnitedHealthcare	$18,662 - $109,272	132%
Blue Cross Blue Shield	$18,848 - $92,968	134%
Kaiser Mcal	$32,671	231%
Medi-Cal	$32,671	231%
Ah Employee Health Plan - All Plans	$33,591	238%
Ca Health And Wellness- All Plans	$49,115	348%
Celtic Mcaid-All Plans	$60,794	431%
Partnership Hp Mcal -All Plans	$65,863	467%
Bc Mcal	$68,560	486%
Aetna	$88,942	630%
Kaiser-All Other Plans	$95,610	677%
Healthnet Comm-All Other Plans	$96,113	681%
Blue Shield Uc Care Members	$100,642	713%
Cigna	$108,278	767%
First Health-All Plans	$110,077	780%
Interplan-All Plans	$113,222	802%
Phcs-All Plans	$113,222	802%
Blue Shield-All Other Plans	$119,513	847%
Multiplan-All Plans	$119,513	847%

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 $27,677.
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 and Rideout 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.