Sepsis treatment (inpatient stay)
Facility: Phillips County Hospital
Billing Code: 871 (MS-DRG)
- CPT Billing Code: 871
- Insurance Median: $7,172
- Cash Discount Price: $7,928
- vs. Medicare Baseline: 0.51x 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 | $5,550 | 39% |
| Medicaid / KanCare | $7,172 | 51% |
| Health Partners-All Plans | $9,327 | 66% |
Consumer Guidance & Cost Commentary
For the procedure code 871, representing sepsis treatment in an inpatient stay at Phillips County Hospital, the cash median price is $7,928.00, which is lower than the facility's gross charge of $9,327.00. While the hospital is a Critical Access Hospital in Phillipsburg, KS, and is government-owned, the data does not provide specific county or state average figures for this code to make a direct comparison. However, the negotiated rate for Medicaid/KanCare is $7,172.00, which is lower than the cash price, illustrating that for patients with this specific insurance coverage, the contracted rate may be more favorable than paying out-of-pocket.
When evaluating the cost relative to Medicare, the facility's allowed amount of $14,116.91 is significantly higher than the cash price, highlighting the potential for substantial savings by paying directly. It is important to note that commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the baseline price compared to cash payments. Patients should verify their deductible status before scheduling, as high negotiated rates may not apply if the deductible has not been met. Additionally, asking the hospital about "self-pay" or "prompt-pay" discounts prior to check-in can help bypass the costly insurance billing cycle and potentially reduce the final bill further.