Sepsis treatment (inpatient stay)
Facility: Cloud County Health Center
Billing Code: 871 (MS-DRG)
- CPT Billing Code: 871
- Insurance Median: $40,634
- Cash Discount Price: $29,941
- vs. Medicare Baseline: 2.88x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 288% of the Medicare baseline (a markup of 188%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Aetna | $38,495 - $39,779 | 273% |
| Mpi-All Plans | $40,634 | 288% |
| Pponext-All Plans | $40,634 | 288% |
| Health Partners - All Plans | $40,634 | 288% |
Consumer Guidance & Cost Commentary
For the procedure code 871, "Sepsis treatment (inpatient stay)," Cloud County Health Center in Concordia, KS, lists a gross charge of $42,773.00. While the facility's cash median rate is $29,941.00, which is lower than the negotiated rates of $40,634.00 paid by major payers like Aetna, Mpi-All Plans, and Pponext-All Plans, patients should be aware that commercial insurance rates often exceed cash prices due to administrative overhead and contract structures. If you have a high-deductible plan, paying the cash rate directly might result in lower out-of-pocket costs compared to your insurance's negotiated allowed amount, provided you qualify for the cash price. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available before scheduling, as these incentives can further reduce the final bill.
This service is categorized under the MS-DRG for sepsis treatment at a Critical Access Hospital, with a Medicare benchmark amount of $14,116.91. The facility's negotiated rate of $40,634.00 represents a significant markup relative to the Medicare baseline, illustrating how commercial rates can differ substantially from federal cost standards. To ensure you are not overcharged, you should request a full itemized bill rather than accepting a summary invoice, as detailed statements allow you to verify that no unbundled codes or services not rendered have been included. If you receive a balance bill from an out-of-network provider at this in-network facility, you may be entitled to protections under the No