CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Adventist Health Twin Cities

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $42,820
Cash Discount Price: $14,395
vs. Medicare Baseline: 3.03x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Adventist Health Twin Cities is $42,820. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $14,395. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 3.03x the Medicare baseline. Located in 1100 Las Tablas Rd, Templeton, CA.

Cash / Self-Pay

$14,395

Average discount available for prompt cash payment at this facility.

Insurance Median

$42,820

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: $14,395 (102%)

Insurance Median: $42,820 (303%)

Cash: $14,395 (102% of Medicare)

Ins. Median: $42,820 (303% 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 303% of the Medicare baseline (a markup of 203%). 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
Aetna	$18,597 - $55,100	132%
Cencal Mcr Adv - All Other Plans	$18,597	132%
Tricare	$18,597	132%
UnitedHealthcare	$18,597 - $108,434	132%
Hpn-Heritage Prov Ntwrk-All Plans	$21,600	153%
Coalinga-All Plans	$24,176	171%
Ccah-Centrl Ca Allince Mcal-All Plans	$25,130	178%
Medi-Cal	$25,684	182%
Cencal Mcal	$29,280	207%
Blue Shield Promise Mcal	$30,872	219%
Ah Employee Health Plan - All Plans	$33,474	237%
Nbd-Ntwrks By Design Exlus-All Other Plans	$52,166	370%
Blue Shield Epn	$53,340	378%
Blue Shield Hmo/Pos	$60,936	432%
Nbd-Ntwrks By Design Non-Exlus	$63,384	449%
Blue Shield Epo/Ppo - All Other Plans	$71,688	508%
Chn-Community Hlth Ntwrk-All Plans	$164,510	1165%
Pacific Health Alliance-All Plans	$185,074	1311%

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 $14,395.
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 Adventist Health Twin Cities 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.