Sepsis treatment (inpatient stay)
Facility: Amberwell Atchison Association
Billing Code: 871 (MS-DRG)
- CPT Billing Code: 871
- Insurance Median: $15,055
- Cash Discount Price: $27,373
- vs. Medicare Baseline: 1.07x 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 | $9,820 - $16,087 | 70% |
| Multiplan - All Plans | $10,890 | 77% |
| Humana | $13,230 - $15,008 | 94% |
| Triwest - All Plans | $15,008 | 106% |
| Va Ccn - All Plans | $15,008 | 106% |
| Superior Select Mcr Adv - All Plans | $15,008 | 106% |
| Cigna | $15,055 | 107% |
| Blue Cross Blue Shield | $16,333 - $17,193 | 116% |
| Aetna | $16,424 | 116% |
| Oscar - All Plans | $20,529 | 145% |
| Centrus Health Direct - All Plans | $21,898 | 155% |
| Ambetter / Centene | $23,262 | 165% |
| Wppa Providrs Care - All Plans | $24,635 | 175% |
Consumer Guidance & Cost Commentary
For the procedure code 871, representing sepsis treatment at Amberwell Atchison Association in Atchison, KS, the cash median price is $27,373.00, which matches the facility's gross charge. This amount is significantly higher than the Medicare benchmark of $14,116.91, indicating a markup of 1.1 times the federal baseline. While the facility is a Critical Access Hospital with voluntary non-profit ownership, the cash rate does not align with typical fair pricing standards, which generally fall between 120% and 150% of the Medicare rate. Patients should be aware that while commercial negotiated rates for this service range from $9,820 to $24,635 depending on the insurance plan, these amounts often exceed the cash price, making self-pay a potentially more economical option for those with high-deductible plans.
To minimize out-of-pocket costs, patients are encouraged to verify "self-pay" or "prompt-pay" discounts directly with the hospital before scheduling, as these upfront payment incentives can bypass the administrative overhead associated with insurance billing. It is important to note that even though many payers have negotiated rates, these amounts may not reflect the lowest possible price if the patient's deductible has not yet been met. Furthermore, since the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients should avoid signing out-of-network cost waivers and request a full itemized billing audit to ensure no unbundled codes or services not rendered are included in the final statement.