Sepsis treatment (inpatient stay)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 871 (MS-DRG)
- CPT Billing Code: 871
- Insurance Median: $2,607
- Cash Discount Price: $11,339
- vs. Medicare Baseline: 0.18x 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 |
|---|---|---|
| Aetna | $2,287 | 16% |
| UnitedHealthcare | $2,927 | 21% |
| Blue Cross Blue Shield | $17,657 | 125% |
Consumer Guidance & Cost Commentary
For this procedure, Community Memorial Healthcare, Inc. in Marysville, KS, lists a cash median price of $11,339.00, which matches the facility's gross charge. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that insurance negotiated rates for this service can sometimes exceed the cash price. For instance, UnitedHealthcare's negotiated rate is $2,927, while Blue Cross Blue Shield's rate is $17,657. If you have a high-deductible plan where your out-of-pocket costs exceed the cash price, paying directly might result in lower total costs compared to using insurance, provided you qualify for the facility's prompt-pay discounts. It is essential to contact the hospital directly to confirm self-pay or prompt-pay rates before scheduling, as these discounts can significantly reduce the final amount owed.
The data indicates that the cash median of $11,339.00 is significantly higher than the median paid amount of $1,064.00, highlighting the substantial difference between billed charges and what insurers actually remit. When comparing this to the Medicare benchmark of $14,116.91, the cash price represents a 0.2% variance, suggesting the facility's pricing aligns closely with federal reimbursement standards for this specific MS-DRG. To ensure you are not overcharged, you should request a full itemized billing audit rather than accepting a summary bill, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you receive a balance bill for out-of-network ancillary services, remember that the No Surprises