Sepsis treatment (inpatient stay)
Facility: Golden Valley Memorial Hospital
Billing Code: 871 (MS-DRG)
- CPT Billing Code: 871
- Insurance Median: $17,367
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.23x 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 | $2,910 - $17,367 | 21% |
| Home State Health | $3,080 | 22% |
| Aetna | $17,367 | 123% |
| Humana | $17,367 | 123% |
| Ambetter / Centene | $20,841 | 148% |
Consumer Guidance & Cost Commentary
For the procedure Sepsis treatment (inpatient stay) at Golden Valley Memorial Hospital in Clinton, Missouri, the most significant benchmark available is the Medicare rate of $14,116.91. This federal baseline serves as the objective standard for evaluating the facility's pricing, with the commercial negotiated rate for this service set at $17,367. While the data does not provide specific state or county average figures for this procedure, the Medicare rate of $14,116.91 offers a scientifically validated cost basis that reveals the markup inherent in commercial contracts. Patients should be aware that commercial rates often exceed Medicare benchmarks due to administrative overhead and contract dynamics, and the $17,367 negotiated rate reflects the maximum amount insurers agree to pay under their specific plans.
The financial impact on a patient varies significantly depending on their insurance status and payment method. The median negotiated rate across five payers ranges from a low of $2,910 with UnitedHealthcare to a high of $20,841 with Ambetter / Centene, meaning a patient's out-of-pocket cost could fall anywhere within this spread based on their specific plan. For individuals with high-deductible plans who have not yet met their financial responsibility threshold, the cash-pay option may be more advantageous, as paying directly can sometimes result in a lower total cost than the insurance negotiated rate if the latter exceeds the cash price. It is crucial for patients to verify "self-pay" or "prompt-pay" discounts directly with the hospital before scheduling, as these upfront incentives can reduce the final bill by bypassing the costly insurance claims processing cycle and administrative markups.