Sepsis treatment (inpatient stay)
Facility: Hiawatha Community Hospital
Billing Code: 871 (MS-DRG)
- CPT Billing Code: 871
- Insurance Median: $20,165
- Cash Discount Price: $30,849
- vs. Medicare Baseline: 1.43x 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 |
|---|---|---|
| Wppa Providrs Care - All Plans | $7,382 | 52% |
| Healthy Blue Mcaid - All Plans | $7,942 | 56% |
| UnitedHealthcare | $10,872 - $26,499 | 77% |
| Aetna | $10,872 - $25,851 | 77% |
| Humana | $10,872 | 77% |
| Ambetter / Centene | $13,046 | 92% |
| Blue Cross Blue Shield | $16,333 - $17,193 | 116% |
| Oscar - All Plans | $23,137 | 164% |
| Centrus Health Direct - All Plans | $24,679 | 175% |
| Preferred Hlth - All Plans | $27,764 | 197% |
| Cigna | $29,306 | 208% |
| Midlands Choice - All Plans | $29,923 | 212% |
| Multiplan - All Plans | $29,923 | 212% |
Consumer Guidance & Cost Commentary
For the procedure "Sepsis treatment (inpatient stay)" at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $30,849.00, which matches the facility's median paid amount. This cash rate is significantly higher than the Medicare benchmark of $14,116.91, reflecting a markup of 140% above the federal baseline. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should note that commercial insurance negotiated rates vary widely among payers, ranging from a low of $7,382 with Wppa Providers Care to a high of $29,923 with Midlands Choice. Because these negotiated rates often include administrative overhead and contract premiums, they can sometimes exceed the cash price, making self-pay a potentially more cost-effective option for those with high-deductible plans who have not yet met their out-of-pocket maximums.
To secure the lowest possible price, patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling their visit, as hospitals often offer fee reductions of 20% to 50% for upfront payment that bypass costly insurance billing cycles. It is also important to verify the specific allowed amounts for your insurance plan, as in-network rates are not uniform across all providers; some commercial payers may negotiate rates that are substantially higher than the cash price. Finally, if you receive a bill, always demand a full itemized statement rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be corrected through a formal written audit dispute.