CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Tj Health Columbia

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $13,698
Cash Discount Price: $11,031
vs. Medicare Baseline: 0.97x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Tj Health Columbia is $13,698. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $11,031. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 0.97x the Medicare baseline. Located in 901 Westlake Drive, Columbia, KY.

Cash / Self-Pay

$11,031

Average discount available for prompt cash payment at this facility.

Insurance Median

$13,698

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: $11,031 (78%)

Insurance Median: $13,698 (97%)

Cash: $11,031 (78% of Medicare)

Ins. Median: $13,698 (97% 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
Center Care Select - All Plans	$9,334	66%
Aetna	$10,741	76%
Blue Cross Blue Shield	$11,934 - $16,971	85%
Humana	$11,934 - $13,429	85%
Molina Mcaid	$12,292	87%
UnitedHealthcare	$13,390	95%
Signature Advantage - All Plans	$13,564	96%
Molina Mcr Adv	$13,698	97%
Devoted Mcr Adv - All Plans	$14,101	100%
Phcs/Multiplan - All Plans	$15,953	113%
First Health - All Plans	$16,123	114%
Caresource - All Plans	$16,971	120%
Molina Marketplace - All Other Plans	$16,971	120%

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 $11,031.
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 Tj Health Columbia 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.