CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Robert Wood Johnson University Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $42,383
Cash Discount Price: $4,122
vs. Medicare Baseline: 3.00x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Robert Wood Johnson University Hospital is $42,383. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,122. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 3.00x the Medicare baseline. Located in One Robert Wood Johnson Place, New Brunswick, NJ.

Cash / Self-Pay

$4,122

Average discount available for prompt cash payment at this facility.

Insurance Median

$42,383

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: $4,122 (29%)

Insurance Median: $42,383 (300%)

Cash: $4,122 (29% of Medicare)

Ins. Median: $42,383 (300% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 300% of the Medicare baseline (a markup of 200%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Qualcare Inc	$5,918 - $84,766	42%
Blue Cross Blue Shield	$8,354 - $60,568	59%
Aetna	$20,157 - $60,124	143%
Clover Health	$20,157	143%
Fidelis Care	$20,157	143%
Humana	$20,157	143%
Wellpoint	$20,157	143%
UnitedHealthcare	$20,560 - $58,867	146%
Emblem Health	$39,562	280%
Wellcare	$40,112	284%
Amerihealth	$41,272 - $49,734	292%
Cigna	$52,153 - $54,929	369%

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 $4,122.
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 Robert Wood Johnson University 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.