CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: T J Samson Community Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $15,054
Cash Discount Price: $13,950
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at T J Samson Community Hospital is $15,054. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $13,950. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.07x the Medicare baseline. Located in 1301 North Race Street, Glasgow, KY.

Cash / Self-Pay

$13,950

Average discount available for prompt cash payment at this facility.

Insurance Median

$15,054

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14,116.91

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14,116.91 (100%)

Cash / Self-Pay: $13,950 (99%)

Insurance Median: $15,054 (107%)

Cash: $13,950 (99% of Medicare)

Ins. Median: $15,054 (107% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Cross Blue Shield	$8,310 - $20,774	59%
Aetna	$13,200	94%
Humana	$13,895 - $14,506	98%
Wellcare Mcaid	$13,895	98%
Molina Mcaid	$14,312	101%
Wellcare Mcr Adv - All Other Plans	$14,506	103%
Signature Health - All Plans	$14,651	104%
Molina Mcr Adv	$14,796	105%
UnitedHealthcare	$14,878	105%
Devoted Mcr Adv - All Plans	$15,231	108%
Center Care Select - All Plans	$18,242	129%
Phcs/Multiplan - All Plans	$20,173	143%
First Health - All Plans	$20,388	144%
Caresource - All Plans	$21,461	152%
Molina Marketplace - All Other Plans	$21,461	152%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $13,950.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 871.

Insurance In-Network Protection Plan

Contact your insurance company to confirm T J Samson Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 871.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.