CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Progress West Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $21,605
Cash Discount Price: $27,910
vs. Medicare Baseline: 1.53x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Progress West Hospital is $21,605. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $27,910. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.53x the Medicare baseline. Located in 2 Progress Point Pkwy, Ofallon, MO.

Cash / Self-Pay

$27,910

Average discount available for prompt cash payment at this facility.

Insurance Median

$21,605

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: $27,910 (198%)

Insurance Median: $21,605 (153%)

Cash: $27,910 (198% of Medicare)

Ins. Median: $21,605 (153% 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
Aetna	$15,062	107%
Blue Cross Blue Shield	$15,062 - $31,221	107%
Essence Healthcare [221]	$15,062	107%
Humana	$15,062	107%
UnitedHealthcare	$15,062 - $31,505	107%
Cox Health [757]	$15,815	112%
Devoted Health Plan [847]	$15,815	112%
Medica [662]	$15,815	112%
Cigna	$19,682 - $30,008	139%
Health Alliance [224]	$21,605	153%
Consociate [478]	$22,951 - $26,395	163%
Sarah Bush Lincoln [636]	$26,395	187%
Apwu Health Plan [216]	$30,008	213%
Nalc Health Benefit Plan [242]	$30,008	213%
Priority Health [648]	$30,008	213%
Healthscope Benefits [258]	$31,505	223%

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 $27,910.
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 Progress West 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.