CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: St Mary's General Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $25,205
Cash Discount Price: $24,005
vs. Medicare Baseline: 1.79x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at St Mary's General Hospital is $25,205. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $24,005. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.79x the Medicare baseline. Located in 350 Boulevard, Passaic, NJ.

Cash / Self-Pay

$24,005

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,205

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: $24,005 (170%)

Insurance Median: $25,205 (179%)

Cash: $24,005 (170% of Medicare)

Ins. Median: $25,205 (179% 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
Horizon	$11,592 - $19,582	82%
Humana	$19,204	136%
Aetna	$19,582 - $43,449	139%
Amerihealth	$19,582	139%
Clover Health	$19,582	139%
Ubh	$19,582	139%
UnitedHealthcare	$19,582 - $34,757	139%
Wellcare	$19,582 - $32,407	139%
Wellpoint Amerigroup	$19,582	139%
Tricare	$21,463	152%
Medicare (plans)	$24,005	170%
Ally-Align (Fka Spartan Plan Nj, Inc.)	$25,205	179%
Cigna	$28,419	201%
Employer Direct Healthcare	$31,207	221%
Fairprice Healthcare Holdings	$38,408	272%
Coventry	$40,809	289%

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 $24,005.
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 St Mary's General 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.