CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Garden Grove Hospital & Medical Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $18,758
Cash Discount Price: $18,664
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Garden Grove Hospital & Medical Center is $18,758. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18,664. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.33x the Medicare baseline. Located in 12601 Garden Grove Blvd, Garden Grove, CA.

Cash / Self-Pay

$18,664

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,758

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: $18,664 (132%)

Insurance Median: $18,758 (133%)

Cash: $18,664 (132% of Medicare)

Ins. Median: $18,758 (133% 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.

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 Of Ca	$18,664	132%
Central Health Plan	$18,664	132%
Health Net Of Ca	$18,664 - $33,820	132%
Innovative Mgmt Svcs	$18,664	132%
Medcare Partners Health Plan	$18,664	132%
Medicare (plans)	$18,664	132%
Molina	$18,664	132%
Patient Choice Health Plan	$18,664	132%
Renal Payer Solutions	$18,664	132%
Verda Healthplan	$18,664	132%
Brand New Day	$18,851	134%
Tricare	$19,396	137%
Imperial Health Plan Of Ca	$19,784	140%
Employer Direct Healthcare	$24,264	172%
Aetna	$28,437	201%
Naphcare	$28,930	205%
National Healthcare Solutions, Inc (Nhsi)	$29,863	212%
Workers Compensation	$36,349	257%

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 $18,664.
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 Garden Grove Hospital & Medical Center 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.