CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Banner Heart Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $15,299
Cash Discount Price: $21,756
vs. Medicare Baseline: 1.08x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Banner Heart Hospital is $15,299. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21,756. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.08x the Medicare baseline. Located in 6750 East Baywood Avenue, Mesa, AZ.

Cash / Self-Pay

$21,756

Average discount available for prompt cash payment at this facility.

Insurance Median

$15,299

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: $21,756 (154%)

Insurance Median: $15,299 (108%)

Cash: $21,756 (154% of Medicare)

Ins. Median: $15,299 (108% 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
Aetna	$14,571 - $52,229	103%
Arizona Physicians Ipa	$14,571	103%
Banner Health	$14,571	103%
Banner University Health Plan	$14,571	103%
Blue Cross Blue Shield	$14,571 - $42,700	103%
Care 1St	$14,571	103%
Cigna	$14,571 - $59,383	103%
Gila River Health Care Corporation	$14,571	103%
Health Choice Arizona, Inc.	$14,571 - $21,856	103%
Health Net	$14,571 - $21,565	103%
Humana	$14,571 - $15,008	103%
Kaiser Foundation Health Plan	$14,571	103%
Mercy Care	$14,571	103%
Triwest Healthcare Alliance Corp - Va Ccn	$14,571	103%
UnitedHealthcare	$14,571 - $52,031	103%
Upmc Health Plan	$14,571	103%
Wellpoint	$14,571	103%
Carelon	$15,299	108%
Devoted Health Services	$15,299	108%
Arizona Priority Care	$16,028	114%
Gold Kidney Health Plan	$16,028	114%
Oscar Health Plan	$24,042	170%

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 $21,756.
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 Banner Heart 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.