CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Providence Mission Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 871
  • Insurance Median: $19,052
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.35x Medicare
The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Providence Mission Hospital is $19,052. 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 1.35x the Medicare baseline. Located in 27700 Medical Center Rd, Mission Viejo, CA.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$19,052

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: $19,052 (135%)
Ins. Median: $19,052 (135% 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 $19,052 135%
Blue Cross Blue Shield $19,052 - $26,781 135%
Blue Shield $19,052 - $33,839 135%
Brand New Day $19,052 135%
Caremore $19,052 135%
Central Health Plan $19,052 135%
Cigna $19,052 135%
Healthcare Partners $19,052 135%
Healthnet $19,052 - $45,368 135%
Heritage Provider Network $19,052 135%
Humana $19,052 135%
Inland Empire Health Plan $19,052 135%
Kaiser $19,052 135%
Molina $19,052 135%
Monarch Health Plan $19,052 135%
One Care $19,052 135%
Providence Health Plan $19,052 135%
Scan $19,052 135%
UnitedHealthcare $19,052 - $47,032 135%
Wellcare $19,052 135%
Providence $21,556 153%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 27700 Medical Center Rd, Mission Viejo, CA 92691
  • CMS Rating: ★★★★★
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals