CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Ocean Medical Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $19,869
Cash Discount Price: $16,662
vs. Medicare Baseline: 1.41x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Ocean Medical Center is $19,869. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16,662. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.41x the Medicare baseline. Located in 425 Jack Martin Blvd, Brick, NJ.

Cash / Self-Pay

$16,662

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,869

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: $16,662 (118%)

Insurance Median: $19,869 (141%)

Cash: $16,662 (118% of Medicare)

Ins. Median: $19,869 (141% 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	$9,722 - $53,999	69%
Amerihealth	$14,186	100%
Vaccn	$16,195 - $17,130	115%
Aetna	$17,740 - $54,733	126%
Amerigroup	$17,740 - $17,880	126%
Wellcare	$17,740 - $17,880	126%
Blue Cross Blue Shield	$17,880	127%
United Community/Americhoice	$18,627 - $18,774	132%
Clover	$19,668	139%
Seoul Medical Group	$19,869 - $20,026	141%
UnitedHealthcare	$21,456 - $75,150	152%
Karna	$25,329 - $25,516	179%
Cigna	$55,759 - $65,917	395%
Oxford	$62,887	445%
Brighton Health Plan	$63,123	447%

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 $16,662.
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 Ocean Medical Center 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.