Sepsis treatment (inpatient stay)
Facility: Rooks County Health Center
Billing Code: 871 (MS-DRG)
- CPT Billing Code: 871
- Insurance Median: $13,998
- Cash Discount Price: $11,665
- vs. Medicare Baseline: 0.99x 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 |
|---|---|---|
| Healthy Blue Mcaid - All Plans | $7,942 | 56% |
| Veterans Admin - All Plans | $13,520 | 96% |
| Tricare | $13,520 | 96% |
| Celtic Mcr Adv | $13,520 | 96% |
| Preferred Benefits Admin | $13,998 | 99% |
| UnitedHealthcare | $13,998 | 99% |
| Aetna | $13,998 | 99% |
| Health Partners - All Plans | $14,775 | 105% |
| Preferred Hlthcare - All Other Plans | $14,775 | 105% |
| Celtic Comm - All Other Plans | $14,872 | 105% |
| Blue Cross Blue Shield | $17,657 | 125% |
Consumer Guidance & Cost Commentary
For this inpatient sepsis treatment at Rooks County Health Center in Plainville, KS, the facility's cash median rate is $11,665, which is lower than the median negotiated rate of $13,998 paid by most major payers. While the facility is a Critical Access Hospital with government ownership, patients should be aware that commercial insurance contracts often result in higher out-of-pocket costs than paying cash directly. If you have a high-deductible plan, paying the cash price of $11,665 upfront could save you money compared to your insurance's negotiated rate of $13,998, provided you have not yet met your deductible. It is important to verify your specific plan's allowed amount before scheduling, as some in-network contracts may exceed the cash price due to administrative overhead and contract dynamics.
The data indicates that the facility's cash rate is significantly lower than the gross chargemaster of $15,553, highlighting the potential for substantial savings through prompt-pay discounts or self-pay arrangements. Since the facility is located in a rural area (ZIP 67663), patients should proactively request a "waiver of insurance submission" at registration to ensure the hospital applies the cash price rather than submitting a claim that could trigger balance billing or higher negotiated rates. If you receive a bill that exceeds the cash price, you should request an itemized audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected. Always confirm with the billing department whether "self-pay" or "prompt-pay" discounts are available before finalizing payment to ensure you are not paying more