Sepsis treatment (inpatient stay)
Facility: Clara Barton Hospital
Billing Code: 871 (MS-DRG)
- CPT Billing Code: 871
- Insurance Median: $16,458
- Cash Discount Price: $12,801
- vs. Medicare Baseline: 1.17x 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 |
|---|---|---|
| 6 Degrees Health - All Plans | $12,801 | 91% |
| Wppa-All Plans | $14,629 | 104% |
| Blue Cross Blue Shield | $15,888 | 113% |
| Phcs - All Plans | $16,458 | 117% |
| UnitedHealthcare | $16,458 | 117% |
| Aetna | $16,458 | 117% |
| Hlth Partners Of Ks-All Plans | $16,824 | 119% |
Consumer Guidance & Cost Commentary
For this procedure at Clara Barton Hospital in Hoisington, KS, the cash price of $12,801 is lower than the negotiated rates paid by major insurers like Blue Cross Blue Shield and UnitedHealthcare, which average $16,458. While commercial insurance contracts often include administrative fees that inflate the final bill, paying cash upfront can result in significant savings for patients with high-deductible plans who may not have met their out-of-pocket limits. Because the cash rate is the lowest available option in this dataset, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these programs can further reduce the total cost by bypassing insurance billing cycles.
The facility's cash rate of $12,801 is notably lower than the Medicare benchmark of $14,117, which serves as a scientifically validated baseline for the true cost of care. Although the hospital is a Critical Access Hospital with a voluntary non-profit ownership structure, the gap between the cash price and the Medicare rate highlights that commercial negotiated rates are not always the most economical choice. To ensure you are not overcharged, always request a full itemized bill rather than accepting a summary invoice, and verify that no unexpected out-of-network services triggered balance billing, as federal protections like the No Surprises Act may limit such charges for emergency care at in-network facilities.