CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Adventist Health Castle

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $22,874
Cash Discount Price: $15,639
vs. Medicare Baseline: 1.62x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Adventist Health Castle is $22,874. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15,639. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.62x the Medicare baseline. Located in 640 Ulukahiki St, Kailua, HI.

Cash / Self-Pay

$15,639

Average discount available for prompt cash payment at this facility.

Insurance Median

$22,874

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: $15,639 (111%)

Insurance Median: $22,874 (162%)

Cash: $15,639 (111% of Medicare)

Ins. Median: $22,874 (162% 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
Hmsa Quest Abd	$3,450	24%
Hmsa Quest Non-Abd	$3,450	24%
Medicaid / KanCare	$13,635	97%
Ohana Health Plan - All Plans	$13,635	97%
UnitedHealthcare	$13,635	97%
Kfh - All Other Plans	$16,263	115%
Hwmg/Hmaa - All Plans	$16,410	116%
Kfh Mcr Adv	$18,684	132%
Medicare (plans)	$18,684	132%
Devoted Hlth Mcr Adv - All Plans	$19,618	139%
Mdx Hawaii Ppo - All Plans	$22,874	162%
Alohacare Quest Mcaid - All Other Plans	$24,436	173%
Pacific Admin Ppo - All Plans	$25,169	178%
Uni Health Alliance - All Plans	$27,307	193%
Magellan Bh Ip Only - All Plans	$29,323	208%
State Of Hi Nonprofit - All Plans	$30,829	218%
Hmsa Hmo	$40,183	285%
Hmsa Ppo - All Other Plans	$40,183	285%
Health Alliance - All Plans	$43,185	306%
Multiplan Hmn - All Plans	$44,924	318%
First Health Ppo - All Plans	$45,939	325%

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 $15,639.
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 Castle 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.