CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Methodist Hospitals Inc

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $26,410
Cash Discount Price: $60,591
vs. Medicare Baseline: 1.87x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Methodist Hospitals Inc is $26,410. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $60,591. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.87x the Medicare baseline. Located in 600 Grant St, Gary, IN.

Cash / Self-Pay

$60,591

Average discount available for prompt cash payment at this facility.

Insurance Median

$26,410

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: $60,591 (429%)

Insurance Median: $26,410 (187%)

Cash: $60,591 (429% of Medicare)

Ins. Median: $26,410 (187% 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	$11,202 - $29,965	79%
Aetna	$16,006 - $42,727	113%
Humana	$16,006	113%
Medicare (plans)	$16,006	113%
United Heathcare	$16,006	113%
Zing	$16,326	116%
Caresource Maketplace	$26,410	187%
UnitedHealthcare	$26,705 - $28,714	189%
Ambetter / Centene	$32,012	227%
Siho	$48,085	341%
Magnacare	$72,261	512%

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 $60,591.
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 Methodist Hospitals Inc 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.