Sepsis treatment (inpatient stay)
Facility: Memorial Hospital
Billing Code: 871 (MS-DRG)
- CPT Billing Code: 871
- Insurance Median: $18,426
- Cash Discount Price: $29,738
- vs. Medicare Baseline: 1.31x 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/Providers Care-All Plans | $13,598 | 96% |
| Blue Cross Blue Shield | $15,547 | 110% |
| Humana | $18,244 | 129% |
| Tricare | $18,244 | 129% |
| Medicare (plans) | $18,426 | 131% |
| Ambetter / Centene | $20,068 | 142% |
| Coventry - All Other Plans | $26,764 | 190% |
| Preferred Healthcare-All Plans | $28,251 | 200% |
| Health Partners Of Kansas - All Plans | $28,251 | 200% |
Consumer Guidance & Cost Commentary
For the procedure code 871, representing sepsis treatment at Memorial Hospital in Abilene, KS, the cash price is $29,738.00, which matches the facility's median negotiated rate. This cash price is significantly higher than the Medicare benchmark of $14,116.91, reflecting a markup of 1.3 times the federal rate. While commercial payers negotiate rates ranging from $13,598 to $28,251, the cash price remains the highest figure in this dataset. Patients with high-deductible plans may find paying the cash price directly more advantageous than using insurance, as the negotiated rates for most commercial plans exceed the cash amount, potentially resulting in higher out-of-pocket costs if deductibles are not yet met.
To minimize costs, patients should proactively request "self-pay" or "prompt-pay" discounts from the hospital before scheduling, as these upfront payment incentives can reduce the total bill by 20% to 50%. It is also important to verify that the facility is in-network with your specific plan, as in-network rates are contractually capped but may still be higher than cash prices due to administrative overhead. Finally, if you receive a bill, always request a full itemized statement to review every line item for errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain discrepancies that can be corrected to lower your final payment.