CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Providence St. Jude Medical Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 871
  • Insurance Median: $19,196
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.36x Medicare
The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Providence St. Jude Medical Center is $19,196. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.36x the Medicare baseline. Located in 101 E Valencia Mesa Drive, Fullerton, CA.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$19,196

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%)
Insurance Median: $19,196 (136%)
Ins. Median: $19,196 (136% 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
Aetna $19,196 136%
Blue Cross Blue Shield $19,196 - $26,781 136%
Blue Shield $19,196 - $38,875 136%
Brand New Day $19,196 136%
Caremore $19,196 136%
Central Health Plan $19,196 136%
Cigna $19,196 136%
Healthcare Partners $19,196 136%
Healthnet $19,196 - $42,533 136%
Heritage Provider Network $19,196 136%
Humana $19,196 136%
Inland Empire Health Plan $19,196 136%
Kaiser $19,196 136%
La Care $19,196 136%
Molina $19,196 136%
Monarch Health Plan $19,196 136%
Onecare $19,196 136%
Providence Health Plan $19,196 136%
Scan $19,196 136%
UnitedHealthcare $19,196 - $45,623 136%
Wellcare $19,196 136%
Providence $22,062 156%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 101 E Valencia Mesa Drive, Fullerton, CA 92835
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals