Sepsis treatment (inpatient stay)
Facility: Holton Community Hospital
Billing Code: 871 (MS-DRG)
- CPT Billing Code: 871
- Insurance Median: $2,806
- Cash Discount Price: $1,030
- vs. Medicare Baseline: 0.20x 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 | $2,806 - $3,662 | 20% |
| Humana | $3,662 | 26% |
| Aetna | $3,699 - $8,715 | 26% |
| Kansas Superior Select - All Plans | $3,735 | 26% |
| Medicaid / KanCare | $8,715 | 62% |
| Blue Cross Blue Shield | $15,888 | 113% |
Consumer Guidance & Cost Commentary
For the procedure "Sepsis treatment (inpatient stay)" at Holton Community Hospital in Holton, KS, the cash price is $1,030.00, which is lower than the facility's gross charge of $1,373.00. While the hospital is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that insurance negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. For instance, UnitedHealthcare's negotiated rate starts at $2,806.00, and Aetna's range from $3,699.00 to $8,715.00, meaning patients with high-deductible plans might save money by paying the cash price directly if they qualify for prompt-pay discounts. It is crucial to verify your specific plan's deductible status before scheduling, as paying the full negotiated amount without meeting your deductible can result in significant out-of-pocket costs.
When evaluating the cost of this service, it is important to compare rates against objective benchmarks rather than the hospital's inflated chargemaster list. The Medicare amount for this code is $14,116.91, which serves as a scientifically validated baseline for "true cost" under the CMS Prospective Payment System. Commercial negotiated rates typically average 200% to 300% of Medicare, whereas fair pricing is generally defined as 120% to 150% of Medicare; however, the specific negotiated rates listed here (ranging from $2,806.00 to $15,888.00) reflect the unique contract terms of each payer. Patients