Sepsis treatment (inpatient stay)
Facility: Stormont Vail Hospital
Billing Code: 871 (MS-DRG)
- CPT Billing Code: 871
- Insurance Median: $14,178
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.00x 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 |
|---|---|---|
| Ambetter / Centene | $8,892 - $17,529 | 63% |
| UnitedHealthcare | $8,892 - $17,529 | 63% |
| Blue Cross Blue Shield | $8,979 - $42,593 | 64% |
| Aetna | $12,714 - $14,178 | 90% |
| Humana | $12,714 - $14,178 | 90% |
Consumer Guidance & Cost Commentary
For CPT code 871, representing sepsis treatment at Stormont Vail Hospital in Topeka, KS, the facility's negotiated rates range from $8,892 to $42,593 depending on the insurance carrier. While the median negotiated rate across payers is $14,178, this figure is significantly higher than the Medicare benchmark of $14,116.91. It is important to note that commercial negotiated rates often include administrative overhead and do not reflect the true cost of care; fair pricing is typically defined as 120% to 150% of the Medicare rate, whereas commercial rates can average 200% to 300%. Because cash-pay rates are not available for this service, patients with high-deductible plans should verify if their specific insurance plan has a lower allowed amount than the facility's negotiated rate, as paying out-of-pocket could sometimes result in a lower total cost if the insurance reimbursement is capped below the patient's out-of-pocket maximum.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency services at in-network facilities, unexpected charges can still occur if ancillary services like laboratory tests are provided by out-of-network providers. To avoid these surprises, consumers should request a full itemized billing audit before paying any invoice, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. Additionally, if a patient chooses to pay directly, they should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the total bill by 20% to 50% by