CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Adventist Health Clearlake

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $71,242
Cash Discount Price: $32,912
vs. Medicare Baseline: 5.05x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Adventist Health Clearlake is $71,242. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32,912. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 5.05x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$32,912

Average discount available for prompt cash payment at this facility.

Insurance Median

$71,242

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: $32,912 (233%)

Insurance Median: $71,242 (505%)

Cash: $32,912 (233% of Medicare)

Ins. Median: $71,242 (505% 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 505% of the Medicare baseline (a markup of 405%). 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
Partnership Mcal - All Plans	$35,128	249%
Ah Employee Health Plan - All Plans	$38,397	272%
Bc Managed Mcal	$38,964	276%
Medi-Cal	$38,964	276%
Blue Shield Mcr Adv	$51,666	366%
Kaiser Mcr Adv	$51,666	366%
Tricare	$51,666	366%
Blue Cross Blue Shield	$53,733 - $186,378	381%
UnitedHealthcare	$56,833 - $76,246	403%
Western Growers- All Plans	$63,995	453%
Blue Shield Epn - All Other Plans	$67,012	475%
Blue Shield Non-Epn	$67,012	475%
Aetna	$68,310	484%
First Health- All Plans	$73,137	518%
Healthnet- All Plans	$74,966	531%
Foundation- All Plans	$77,708	550%
Health Mgmt Network- All Plans	$77,708	550%
Humana	$77,708	550%
Phcs- All Plans	$77,708	550%
Cigna	$82,279	583%
Interplan- All Plans	$82,279	583%
Kaiser- All Other Plans	$82,279	583%
Three Rivers Provider Network- All Plans	$82,279	583%

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 $32,912.
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 Clearlake 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.