CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Saint Alphonsus Medical Center Ontario

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $31,287
Cash Discount Price: $26,685
vs. Medicare Baseline: 2.22x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Saint Alphonsus Medical Center Ontario is $31,287. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $26,685. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 2.22x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.

Cash / Self-Pay

$26,685

Average discount available for prompt cash payment at this facility.

Insurance Median

$31,287

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: $26,685 (189%)

Insurance Median: $31,287 (222%)

Cash: $26,685 (189% of Medicare)

Ins. Median: $31,287 (222% 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 222% of the Medicare baseline (a markup of 122%). 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 Cross Blue Shield	$16,927 - $37,967	120%
Medicare (plans)	$16,927 - $18,137	120%
UnitedHealthcare	$16,927	120%
Aetna	$17,435	124%
American Health Advantage Of Idaho	$17,605	125%
Mountain Health Co-Op	$29,257	207%
Moda Health	$31,091	220%
Selecthealth	$31,287 - $34,608	222%
Healthcare Management Admin	$34,381	244%
Webtpa	$34,546	245%
Blue Benefit Administrators Of Massachusetts	$37,967	269%
Blue Care Network	$37,967	269%
Blue Distinction Transplant	$37,967	269%
Blue Shield - Ca	$37,967	269%
Blue Shield - Id (Regence)	$37,967	269%
Blue Shield - Ny Highmark Northeastern	$37,967	269%
Blue Shield - Ny Highmark Western	$37,967	269%
Blue Shield - Pa (Highmark)	$37,967	269%
Blue Shield - Wa (Regence)	$37,967	269%

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 $26,685.
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 Saint Alphonsus Medical Center Ontario 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.