CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Good Samaritan Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $21,657
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.53x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Good Samaritan Hospital is $21,657. 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 1.53x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$21,657

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: $21,657 (153%)

Ins. Median: $21,657 (153% 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
Healthsmart	$1,915	14%
Multiplan	$3,158	22%
First Health	$3,183 - $5,426	23%
Health Net	$4,316	31%
Cigna	$6,671 - $43,165	47%
United	$7,394 - $21,874	52%
Blue Cross Blue Shield	$7,854 - $49,502	56%
Aetna	$9,384 - $21,657	66%
Blue Shield	$15,300 - $22,090	108%
Vitas Healthcare Hospice	$19,492	138%
Vitality Health Plan	$21,008	149%
Affinity Medical Group	$21,657	153%
Alignment Health Plan	$21,657	153%
Central Health Plan	$21,657	153%
Clever Care Of Golden State	$21,657 - $22,740	153%
Easy Choice Health Plan	$21,657	153%
Humana	$21,657	153%
Medcare Partners	$21,657 - $22,740	153%
On Lok Senior Health	$21,657	153%
Palo Alto Medical	$21,657 - $28,155	153%
Santa Clara Family Health Plan	$21,657	153%
Scan Health Plan	$21,657	153%
Triwest Healthcare Alliance	$21,657	153%
University Healthcare	$21,657	153%
Care1St Health Plan	$22,090	156%
Affinity Medical Group Comm	$28,155	199%
Corvel Corporation	$32,993	234%
Bright Health	$36,559 - $38,091	259%

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 $X.
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 Good Samaritan 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.