Sepsis treatment (inpatient stay)
Facility: St. Catherine Hospital - Garden City
Billing Code: 871 (MS-DRG)
- CPT Billing Code: 871
- Insurance Median: $20,329
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.44x 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 |
|---|---|---|
| UnitedHealthcare | $14,442 - $45,664 | 102% |
| Devoted Health | $14,591 | 103% |
| Cigna | $14,591 - $51,239 | 103% |
| Humana | $14,591 - $20,329 | 103% |
| Blue Cross Blue Shield | $14,591 - $30,140 | 103% |
| Kaiser | $14,591 - $22,264 | 103% |
| Aetna | $14,591 - $31,700 | 103% |
| Medicare (plans) | $14,591 - $20,329 | 103% |
| Innovage | $14,591 | 103% |
| Direct To Employer | $16,321 - $26,469 | 116% |
| Kansas Health | $20,329 | 144% |
| Peak Health | $22,132 | 157% |
| United Colorado Doctor'S Plan | $29,524 | 209% |
Consumer Guidance & Cost Commentary
For code 871, representing sepsis treatment during an inpatient stay at St. Catherine Hospital in Garden City, KS, the facility's negotiated rates range from $14,442 to $31,700 depending on the insurance carrier. These commercial rates are significantly higher than the Medicare benchmark of $14,116.91, which serves as the objective baseline for evaluating hospital pricing markups. While the median negotiated rate across payers is $20,329, patients should be aware that cash-pay options may offer lower costs for those with high-deductible plans, as the cash median is not currently listed but could be lower than the insurance allowed amounts. It is crucial to verify if the facility offers self-pay or prompt-pay discounts, which can reduce bills by 20% to 50% when paid upfront, bypassing the administrative overhead and claim processing costs that inflate insurance rates.
The facility's pricing structure reflects standard commercial dynamics where negotiated rates often average 200% to 300% of Medicare, though fair pricing is typically defined as 120% to 150% of this benchmark. In this case, the lowest negotiated rate of $14,442 from UnitedHealthcare is only slightly above the Medicare amount, while the highest rate of $31,700 from Aetna represents a substantial markup. Patients should avoid comparing these figures to the hospital's gross chargemaster list, as those inflated prices do not reflect actual reimbursement standards. Instead, consumers should request an itemized billing audit to ensure no errors, double-billing, or unbundled codes are present, as