CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Robert Wood Johnson University Hospital - Somerset

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $34,328
Cash Discount Price: $2,486
vs. Medicare Baseline: 2.43x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Robert Wood Johnson University Hospital - Somerset is $34,328. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,486. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 2.43x the Medicare baseline. Located in 110 Rehill Ave, Somerville, NJ.

Cash / Self-Pay

$2,486

Average discount available for prompt cash payment at this facility.

Insurance Median

$34,328

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: $2,486 (18%)

Insurance Median: $34,328 (243%)

Cash: $2,486 (18% of Medicare)

Ins. Median: $34,328 (243% 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 243% of the Medicare baseline (a markup of 143%). 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	$5,565	39%
Blue Cross Blue Shield	$6,377 - $49,845	45%
Aetna	$16,266 - $56,165	115%
Clover Health	$16,266	115%
Fidelis Care	$16,266	115%
Humana	$16,266	115%
Wellpoint	$16,266	115%
UnitedHealthcare	$16,592 - $69,874	118%
Emblem Health	$25,666	182%
Amerihealth	$32,301 - $40,483	229%
Wellcare	$32,370	229%
Cigna	$36,287 - $48,562	257%

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 $2,486.
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 - Somerset 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.