Sepsis treatment (inpatient stay)
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 871 (MS-DRG)
- CPT Billing Code: 871
- Insurance Median: $16,164
- Cash Discount Price: $16,107
- vs. Medicare Baseline: 1.15x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $8,715 - $16,477 | 62% |
| Blue Cross Blue Shield | $8,715 - $21,261 | 62% |
| Aetna | $9,142 - $16,285 | 65% |
| Humana | $9,142 - $16,164 | 65% |
| Tricare | $13,726 | 97% |
| Providrs Care Network Contracted [320484] | $15,152 | 107% |
| Indian Health Service Contracted [320198] | $16,164 | 115% |
| Halo Hcr Inc Hospice [20432] | $16,164 | 115% |
| Kindful Hospice [20434] | $16,164 | 115% |
| Mercy Hospice Okc [20252] | $16,164 | 115% |
| Elara Caring Aspire Hospice [20433] | $16,164 | 115% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $16,164 | 115% |
| Kindful Hospice Contracted [320434] | $16,164 | 115% |
| Pace Of The Ozarks Contracted [320518] | $16,164 | 115% |
| Halo Hcr Inc Hospice Contracted [320432] | $16,164 | 115% |
| Medicare (plans) | $16,164 - $16,205 | 115% |
| Dept Of Veteran Affairs Contracted [320106] | $16,164 | 115% |
| Cross Timbers Hospice [20098] | $16,164 | 115% |
| Medica Contracted [320239] | $16,294 | 115% |
| Home State Health Plan Contracted [320187] | $16,477 | 117% |
| Ambetter / Centene | $16,477 | 117% |
| UnitedHealthcare | $16,477 | 117% |
| Cigna | $19,899 - $23,137 | 141% |
| Health Choice Contracted [320166] | $25,117 | 178% |
Consumer Guidance & Cost Commentary
For the MS-DRG code 871, representing sepsis treatment in an inpatient stay, Mercy Hospital Pittsburg, Inc. has a gross chargemaster rate of $24,780. While the facility's cash median price is $16,107, commercial insurance negotiated rates vary significantly, ranging from a low of $8,715 with Medicaid/KanCare to a high of $25,117 with Health Choice. These negotiated amounts are notably higher than the facility's cash price, illustrating that for patients with high-deductible plans or those who qualify for self-pay discounts, paying cash upfront can result in lower out-of-pocket costs compared to insurance reimbursement. It is important to note that many of the listed payers, including various hospice and government contractors, have fixed negotiated rates between $16,164 and $16,477, which remain above the cash median.
To ensure you are not overpaying, it is recommended to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, while the facility's facility rating is 3, the data indicates that the negotiated rates for this procedure are generally higher than the Medicare benchmark of $14,116.91, with most commercial rates falling between 110% and 200% of the Medicare amount. If you receive a balance bill from an out-of-network provider at this in-network facility, you may be entitled to protections under the No Surprises Act, which bans balance billing for emergency and non-emergency services.