CMS Price Transparency Data
Sepsis treatment (inpatient stay)
Facility: Overlook Medical Center
Billing Code: 871 (MS-DRG)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 871
- Insurance Median: $40,364
- Cash Discount Price: $23,547
- vs. Medicare Baseline: 2.86x Medicare
The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Overlook Medical Center is $40,364. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $23,547. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 2.86x the Medicare baseline. Located in 99 Beauvoir Avenue, Summit, NJ.
Cash / Self-Pay
$23,547
Average discount available for prompt cash payment at this facility.
Insurance Median
$40,364
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: $23,547 (167%)
Insurance Median: $40,364 (286%)
Cash: $23,547 (167% of Medicare)
Ins. Median: $40,364 (286% 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 286% of the Medicare baseline (a markup of 186%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 |
|---|---|---|
| Occunet [5490] | $7,532 | 53% |
| The Fairly Group [5528] | $7,532 | 53% |
| Praxis Workers Comp [5515] | $8,500 | 60% |
| Inservco Workers Compensation [5158] | $8,682 | 62% |
| Medlogix/Consumer Health Network (Chn) [5415] | $8,682 | 62% |
| Gallagher Bassett Workers Comp [5117] | $9,028 | 64% |
| Liberty Mutual Worker's Comp [5174] | $9,028 | 64% |
| Pma Workers Comp [5224] | $9,028 | 64% |
| Sedgwick [5235] | $9,028 | 64% |
| Sentry Worker's Comp [5489] | $9,028 | 64% |
| Travelers Workers Compensation [5250] | $9,028 | 64% |
| Kessler Foundation [5532] | $12,000 | 85% |
| Champva [5354] | $14,971 | 106% |
| Tricare | $14,971 | 106% |
| Us Family Health Plan [5258] | $14,971 | 106% |
| Karen Ann Quinlan [5285] | $15,070 | 107% |
| Aetna | $15,394 - $49,188 | 109% |
| Cigna | $17,105 - $50,595 | 121% |
| Medicare (plans) | $17,105 - $19,780 | 121% |
| Amerihealth Administrators Supplemental [5512] | $17,447 | 124% |
| Amerihealth Medigap [5049] | $17,447 | 124% |
| Wellcare Behavioral Health [5335] | $18,302 | 130% |
| Wellcare Health Plans Ip Splits [5475] | $18,302 | 130% |
| Wellcare Health Plans [5269] | $18,302 | 130% |
| Highmark Wholecare Health Plan Ip Splits [5464] | $18,815 | 133% |
| Highmark Wholecare Health Plan [5413] | $18,815 | 133% |
| UPMC [5455] | $18,815 | 133% |
| VA Community Care Network [5403] | $18,838 | 133% |
| Kindred Giralda Hospital [5341] | $20,721 | 147% |
| Cosmetic Surgery/Lap Band/Gastric Bypass [5289] | $21,663 | 153% |
| Medicaid / KanCare | $21,663 | 153% |
| Omc Pediatric Muscle Lengthening [5360] | $21,663 | 153% |
| Specialty Imaging [5433] | $21,663 | 153% |
| Sedgwick Wtc Health Program Wc [5514] | $23,547 | 167% |
| Wtc Health Program [5273] | $25,117 | 178% |
| Claim Watcher/Homestead [5488] | $32,499 | 230% |
| Fairos [5491] | $35,980 | 255% |
| Ambetter / Centene | $38,806 | 275% |
| Claimdoc [5434] | $41,631 | 295% |
| Blue Cross Blue Shield | $44,425 - $48,288 | 315% |
| Ghi Emblem Health [5122] | $44,722 | 317% |
| Humana | $44,722 | 317% |
| Ila Local 1478-2 Welfare Fund [5448] | $44,722 | 317% |
| Oscar [5213] | $44,722 | 317% |
| Qualcare [5026] | $44,722 | 317% |
| Evolution Healthcare [5438] | $45,996 - $49,188 | 326% |
| Healthez [5445] | $45,996 - $49,188 | 326% |
| Mvp Health Care [5197] | $45,996 | 326% |
| Nalc [5198] | $45,996 | 326% |
| Tufts Health Plan [5344] | $45,996 | 326% |
| Webtpa [5447] | $45,996 - $49,188 | 326% |
| Centivo [5405] | $46,467 - $50,595 | 329% |
| Independence Bc [5479] | $48,288 | 342% |
| Prime Healthcare [5435] | $48,288 | 342% |
| 1199 Seiu Benefit and Pension [5037] | $49,188 | 348% |
| Allied Benefit Systems [5046] | $49,188 - $50,595 | 348% |
| Banner Health Network [5510] | $49,188 | 348% |
| Boon-Chapman [5441] | $49,188 | 348% |
| Christian Brothers Services [5439] | $49,188 | 348% |
| Continental Assurance [5091] | $49,188 | 348% |
| Healthsmart Benefit Solutions [5446] | $49,188 | 348% |
| Luminare Health Benefits [5483] | $49,188 | 348% |
| Marpai Health [5449] | $49,188 | 348% |
| Meritain Health [5185] | $49,188 | 348% |
| Nippon Benefit Life [5201] | $49,188 | 348% |
| Starmark [5240] | $49,188 | 348% |
| Iaa - Insurance Administrators of America [5482] | $50,595 | 358% |
| Oxford Behavioral Health [5291] | $51,203 | 363% |
| Oxford [5024] | $51,203 | 363% |
| UnitedHealthcare | $51,203 - $52,788 | 363% |
| Apwu Healthcare [5053] | $52,788 | 374% |
| Geha [5119] | $52,788 | 374% |
| Golden Rule Insurance [5124] | $52,788 | 374% |
| Harvard Pilgrim Healthcare [5133] | $52,788 | 374% |
| Ntca [5208] | $52,788 | 374% |
| Surest [5437] | $52,788 | 374% |