CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Ascension St Vincent's Riverside

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $11,994
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.85x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Ascension St Vincent's Riverside is $11,994. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 0.85x the Medicare baseline. Located in 1 Shircliff Way, Jacksonville, FL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$11,994

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%)

Insurance Median: $11,994 (85%)

Ins. Median: $11,994 (85% 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
Blue Cross Blue Shield	$2,172 - $24,918	15%
Coventry Ppo High Performance	$7,266	51%
Coventry Hmo	$8,850	63%
Medicaid / KanCare	$9,836	70%
North Florida Surgeons	$10,000	71%
Humana	$11,406 - $16,012	81%
Bc Advantage Mcr Replacement	$11,759	83%
Coventry Mcr Replacement Hmo	$11,759	83%
Heartland Of Hc	$11,759	83%
Medicare (plans)	$11,759 - $11,994	83%
Pace Place	$11,759	83%
Research Study Encore Borland-Groover	$11,759	83%
Veterans Administration	$11,759	83%
Wellcare	$11,759	83%
UnitedHealthcare	$11,876 - $19,683	84%
Careplus Mcr Replacement	$11,994	85%
Cigna	$11,994 - $23,700	85%
Aetna	$12,112 - $24,106	86%
Avmed Empower	$14,888	105%
Bright Health	$15,874	112%
Smarthealth	$16,462	117%
Oscar Health Plan	$18,814	133%
Northwell Direct	$20,000	142%
Employer Direct Healthcare	$20,578	146%
90 Degree Benefits	$21,166	150%
Avmed Exchange	$21,166	150%
Molina Exchange	$21,754	154%
Ambetter / Centene	$22,342	158%
Occunet	$26,457	187%

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 $X.
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 Ascension St Vincent's Riverside 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.