Sepsis treatment (inpatient stay)
Facility: Girard Medical Center
Billing Code: 871 (MS-DRG)
- CPT Billing Code: 871
- Insurance Median: $7,191
- Cash Discount Price: $5,483
- 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 |
|---|---|---|
| Medicare (plans) | $7,191 | 51% |
| Humana | $7,191 | 51% |
| UnitedHealthcare | $7,191 - $8,681 | 51% |
| Kansas Superior Select-All Plans | $7,191 | 51% |
| Ambetter / Centene | $7,191 | 51% |
| Blue Cross Blue Shield | $7,191 - $16,692 | 51% |
| Aetna | $7,191 - $12,584 | 51% |
| Multiplan-All Plans | $8,453 | 60% |
| Uhhis-All Plans | $8,681 | 61% |
Consumer Guidance & Cost Commentary
For CPT code 871, representing sepsis treatment at Girard Medical Center in Girard, Kansas, the facility's negotiated rates range from $7,191 to $8,681 depending on the insurance plan, with a median negotiated amount of $7,191. This rate is significantly lower than the facility's gross charge of $9,138, reflecting the contractual ceilings that protect in-network members. However, for patients with high-deductible plans, the cash price of $5,483 may be more cost-effective than the insurance negotiated rate, as commercial contracts often include administrative overheads that inflate the baseline price. It is important to note that while the facility is a Critical Access Hospital in a rural setting, the specific negotiated rates for this procedure vary across the nine participating payers, with UnitedHealthcare and Blue Cross Blue Shield showing the widest ranges due to multiple plan tiers.
When evaluating the true cost of care, it is essential to compare these rates against the Medicare benchmark rather than the hospital's full chargemaster list. The Medicare reimbursement amount for this service is $14,116.91, which serves as the objective baseline for evaluating pricing markups; commercial negotiated rates are typically a fraction of this federal rate, indicating a substantial discount from the full list price. Patients should be aware that balance billing is generally prohibited for emergency services at in-network facilities under federal law, but unexpected charges can still arise from out-of-network ancillary services like specific lab tests or physician fees. To minimize costs, consumers should request a prompt-pay discount before scheduling, which can reduce the bill by 20% to 50% if paid in