CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: St Francis Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $26,220
Cash Discount Price: $25,023
vs. Medicare Baseline: 1.86x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at St Francis Hospital is $26,220. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25,023. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.86x the Medicare baseline. Located in 7Th and Clayton Sts, Wilmington, DE.

Cash / Self-Pay

$25,023

Average discount available for prompt cash payment at this facility.

Insurance Median

$26,220

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: $25,023 (177%)

Insurance Median: $26,220 (186%)

Cash: $25,023 (177% of Medicare)

Ins. Median: $26,220 (186% 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
Pace-Trinity Health	$2,106	15%
Saint Francis Life	$2,106	15%
Delaware First Health	$5,396	38%
Medicaid / KanCare	$5,827	41%
Blue Cross Blue Shield	$6,604 - $46,827	47%
Cigna	$17,891	127%
Blue Shield - De (Highmark) Medciare Advantage	$18,168	129%
Highmark Health Options Dual Plan	$18,168	129%
Medicare (plans)	$18,168 - $18,586	129%
Aetna	$18,760 - $28,932	133%
Coventry	$18,965	134%
Amerihealth	$26,220	186%
Meritain	$28,932	205%
Trustmark Small Business Benefits	$28,932	205%
Blue Benefit Administrators Of Massachusetts	$46,827	332%
Blue Care Network	$46,827	332%
Blue Distinction Transplant	$46,827	332%
Blue Shield - Ca	$46,827	332%
Blue Shield - Id (Regence)	$46,827	332%
Blue Shield - Ny Highmark Northeastern	$46,827	332%
Blue Shield - Ny Highmark Western	$46,827	332%
Blue Shield - Pa (Highmark)	$46,827	332%
Blue Shield - Wa (Regence)	$46,827	332%

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 $25,023.
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 St Francis 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.