CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Southcoast Hospitals Group

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $23,561
Cash Discount Price: $17,675
vs. Medicare Baseline: 1.67x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Southcoast Hospitals Group is $23,561. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $17,675. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.67x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$17,675

Average discount available for prompt cash payment at this facility.

Insurance Median

$23,561

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: $17,675 (125%)

Insurance Median: $23,561 (167%)

Cash: $17,675 (125% of Medicare)

Ins. Median: $23,561 (167% 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
Medicare (plans)	$13,517 - $20,320	96%
Aetna	$17,669 - $27,754	125%
Blue Cross Blue Shield	$17,669	125%
Evercare [1010304]	$17,669	125%
Tufts Senior Care Options [1010315]	$17,669	125%
UnitedHealthcare	$17,669 - $42,016	125%
Wellsense Health Plan Senior Care Options [1020208	$17,846	126%
Commonwealth Care Alliance [1080501]	$18,199 - $18,376	129%
Tufts [1010701]	$18,866 - $21,155	134%
Eternal Health [1010322]	$19,436	138%
Wellpoint [1000102]	$22,335	158%
Cigna	$22,518 - $25,251	160%
Fallon [1000114]	$24,737	175%
First Health [1000130]	$24,751 - $27,754	175%
Group Insurance Service Center [1013001]	$25,883 - $29,024	183%
Innovative Health Plan [1025001]	$25,883 - $29,024	183%
PHCS [1000125]	$25,883 - $29,024	183%
Priority Health [1015001]	$25,883 - $29,024	183%

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 $17,675.
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 Southcoast Hospitals Group 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.