Sepsis treatment (inpatient stay)
Facility: William Newton Hospital
Billing Code: 871 (MS-DRG)
- CPT Billing Code: 871
- Insurance Median: $11,169
- Cash Discount Price: $25,149
- vs. Medicare Baseline: 0.79x 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 |
|---|---|---|
| Ambetter / Centene | $7,942 - $9,764 | 56% |
| Triwest- All Plans | $9,471 | 67% |
| Blue Cross Blue Shield | $9,764 - $12,575 | 69% |
| UnitedHealthcare | $9,764 - $22,630 | 69% |
| Providrs Care Nexus | $16,599 | 118% |
| Providrs Care - All Other Plans | $18,862 | 134% |
Consumer Guidance & Cost Commentary
For the procedure code 871, representing sepsis treatment at William Newton Hospital in Winfield, Kansas, the cash median price is $25,149. While this facility is a Critical Access Hospital with government ownership, the cash rate is notably higher than the state average for this service. Patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures; for instance, UnitedHealthcare's high-end negotiated rate of $22,630 is still lower than the cash price, yet the facility's median negotiated rate of $11,169 represents a significant discount from the cash amount. Because commercial rates can sometimes be higher than self-pay options, especially for those with high-deductible plans, it is advisable to confirm the exact "self-pay" or "prompt-pay" discount available before scheduling, as these upfront incentives can bypass the standard insurance billing cycle.
When evaluating the financial impact of this care, it is essential to compare the facility's pricing against the Medicare benchmark, which serves as the objective baseline for hospital costs. The Medicare amount for this service is $14,116.91, and the facility's cash rate is approximately 178% of this benchmark, reflecting a markup common in commercial settings where rates often average 200% to 300% of Medicare. If you are using insurance, be cautious of balance billing, as the No Surprises Act protects patients from being billed for the difference between the chargemaster and the allowed amount for emergency care or out-of-network services at in-network facilities. To ensure you are receiving fair pricing, request a detailed itemized bill to verify that no