CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Woodlawn Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $13,926
Cash Discount Price: $24,142
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Woodlawn Hospital is $13,926. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $24,142. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 0.99x the Medicare baseline. Located in 1400 E 9Th St, Rochester, IN.

Cash / Self-Pay

$24,142

Average discount available for prompt cash payment at this facility.

Insurance Median

$13,926

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: $24,142 (171%)

Insurance Median: $13,926 (99%)

Cash: $24,142 (171% of Medicare)

Ins. Median: $13,926 (99% 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	$9,228 - $24,463	65%
Caresource Mcaid Hww	$9,228	65%
Mdwise Excel Hhw & Hcc	$9,228	65%
Mhs Mcaid Hcc	$9,228	65%
Mhs Mcaid Hhw	$9,228	65%
UnitedHealthcare	$9,228 - $24,463	65%
Aetna	$10,712 - $30,579	76%
Caresource Mcaid Hip	$10,712	76%
Caresource Mcr Adv	$10,712	76%
Humana	$10,712 - $25,516	76%
Mdwise Mcaid Excel Hip	$10,712	76%
Mhs Exch Mrktplce-All Other Plans	$10,712	76%
Mhs Mcaid Hip	$10,712	76%
Mhs Mcr Adv	$10,926	77%
Caresource Exch - All Other Plans	$13,926	99%
Ambetter / Centene	$14,247	101%
Cigna	$23,047 - $27,360	163%
Parkview Health Plans-All Plans	$24,142	171%
Partners Direct Health-All Plans	$25,252	179%
Sagamore All Other Grps - All Other Plans	$27,038	192%
Encore Comm-All Plans	$27,360	194%
Phcs/Multiplan-All Plans	$29,935	212%
Community Health Alliance-All Plans	$30,579	217%

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 $24,142.
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 Woodlawn 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.