CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Adventist Health Tulare

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $31,755
Cash Discount Price: $12,716
vs. Medicare Baseline: 2.25x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Adventist Health Tulare is $31,755. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $12,716. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 2.25x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$12,716

Average discount available for prompt cash payment at this facility.

Insurance Median

$31,755

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: $12,716 (90%)

Insurance Median: $31,755 (225%)

Cash: $12,716 (90% of Medicare)

Ins. Median: $31,755 (225% 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 225% of the Medicare baseline (a markup of 125%). 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
Blue Shield Mcare	$10,283	73%
Fhcn Pace Mcr Adv - All Plans	$19,976	142%
Medicare (plans)	$19,976	142%
Prime Health - All Plans	$19,976	142%
Tricare	$19,976	142%
UnitedHealthcare	$19,976 - $26,384	142%
Blue Shield Epn	$20,202	143%
Bright Health - All Plans	$24,087	171%
Prison Hlthcre - All Plans	$25,569	181%
Blue Shield-All Other Plans	$28,056	199%
Aetna	$28,826	204%
Cigna	$31,585	224%
Cal Forensic Med Grp - All Plans	$31,924	226%
Healthnet Medi-Cal	$31,924	226%
Medi-Cal	$31,924	226%
Hs Interplan-All Plans	$35,703	253%
Ah Employee Health Plan - All Plans	$35,956	255%
Incentive Hlth - All Plans	$35,956	255%
Blue Cross Blue Shield	$37,256 - $53,928	264%
Healthnet Hmo/Ppo - All Other Plans	$37,303	264%
Network By Design-All Plans	$39,075	277%
Ccipa Medi-Cal - All Plans	$41,502	294%
Western Growers - All Plans	$44,677	316%
Multiplan - All Plans	$56,888	403%

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 $12,716.
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 Tulare 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.