CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Highland Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $28,445
Cash Discount Price: $63,723
vs. Medicare Baseline: 2.01x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Highland Hospital is $28,445. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63,723. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 2.01x the Medicare baseline. Located in 1411 East 31St Street, Oakland, CA.

Cash / Self-Pay

$63,723

Average discount available for prompt cash payment at this facility.

Insurance Median

$28,445

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: $63,723 (451%)

Insurance Median: $28,445 (201%)

Cash: $63,723 (451% of Medicare)

Ins. Median: $28,445 (201% 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 201% of the Medicare baseline (a markup of 101%). 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
Alameda Alliance Commercial Alternate [4801]	$3,777 - $4,300	27%
Blue Shield [1006001]	$8,286 - $8,825	59%
Aetna	$28,445 - $91,263	201%
Blue Cross Blue Shield	$28,445	201%
Brown Toland Medical Group [1049001]	$28,445	201%
Brown Toland Mgd Mcr Alternate [1802]	$28,445	201%
Medicare (plans)	$28,445	201%
UnitedHealthcare	$44,683 - $49,843	317%

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 $63,723.
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 Highland 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.