Sepsis treatment (inpatient stay)
Facility: Nemaha Valley Community Hospital
Billing Code: 871 (MS-DRG)
- CPT Billing Code: 871
- Insurance Median: $14,436
- Cash Discount Price: $14,900
- vs. Medicare Baseline: 1.02x 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 |
|---|---|---|
| Va Ccn - All Plans | $12,208 | 86% |
| Humana | $12,208 | 86% |
| Aetna | $12,330 - $14,072 | 87% |
| Celtic Comm Exch - All Plans | $13,429 | 95% |
| Partners Direct Health - All Plans | $14,800 | 105% |
| Multiplan - All Plans | $14,900 | 106% |
| Midlands Choice - All Plans | $15,727 | 111% |
| Health Partners - All Plans | $15,727 | 111% |
| Blue Cross Blue Shield | $17,657 | 125% |
Consumer Guidance & Cost Commentary
For the procedure code 871, "Sepsis treatment (inpatient stay)," Nemaha Valley Community Hospital in Seneca, KS, has a cash median price of $14,900 and a median negotiated rate of $14,436. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the cash price aligns closely with the Medicare benchmark of $14,116.91, which serves as the federally established baseline for this service. Unlike many commercial rates that can exceed 200% to 300% of the Medicare amount, this facility's cash rate remains within a fair pricing range of approximately 105% of the Medicare benchmark, suggesting a transparent pricing model that avoids the significant markups often found in commercial billing.
Insurance payers negotiate rates that vary significantly, ranging from a low of $12,208 with Va Ccn and Humana to a high of $17,657 with Blue Cross Blue Shield. It is important to note that while in-network insurance contracts provide a ceiling on charges, they often include administrative overhead that inflates the baseline price by 20% to 40% compared to direct cash payments. For patients with high-deductible plans, paying the cash price of $14,900 upfront may result in lower out-of-pocket costs than the negotiated rates charged by commercial insurers, provided the patient has not yet met their deductible. Patients are encouraged to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing the costly insurance claims processing cycle.