CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Sherman Oaks Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $19,671
Cash Discount Price: $18,661
vs. Medicare Baseline: 1.39x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Sherman Oaks Hospital is $19,671. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18,661. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.39x the Medicare baseline. Located in 4929 Van Nuys Blvd, Sherman Oaks, CA.

Cash / Self-Pay

$18,661

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,671

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: $18,661 (132%)

Insurance Median: $19,671 (139%)

Cash: $18,661 (132% of Medicare)

Ins. Median: $19,671 (139% 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
Aids Healthcare Foundation	$18,662 - $19,035	132%
Alignment	$18,662	132%
Blue Shield Of Ca, Va	$18,662	132%
Elite Health Plan	$18,662	132%
Health Net Of Ca	$18,662 - $33,815	132%
Imperial Health Plan	$18,662	132%
L.A Care Health Plan	$18,662	132%
Managed Health Network	$18,662	132%
Medicare (plans)	$18,662	132%
Molina	$18,662	132%
Renal Payer Solutions	$18,662	132%
Tricare	$18,662 - $19,671	132%
Usa Senior Care Network	$18,662	132%
Brand New Day	$18,848	134%
Corvel	$21,274	151%
Zelis Healthcare	$21,274	151%
Aetna	$21,722	154%
Americas Choice Provider Network	$21,722	154%
Multiplan	$21,722	154%
Prime Health Services	$21,722	154%
Three Rivers	$21,722	154%
Healthsmart Preferred Network	$21,946	155%
Provider Select	$22,170	157%
Provider Network Of America	$22,394	159%
Employer Direct Healthcare	$24,260	172%
Naphcare	$28,926	205%
National Healthcare Solutions, Inc (Nhsi)	$29,859	212%
Ca Foundation For Medical Center	$33,566	238%
Worker Comp	$33,566	238%

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 $18,661.
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 Sherman Oaks 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.