CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Saint Michael's Medical Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $27,503
Cash Discount Price: $25,530
vs. Medicare Baseline: 1.95x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Saint Michael's Medical Center is $27,503. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25,530. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.95x the Medicare baseline. Located in 111 Central Avenue, Newark, NJ.

Cash / Self-Pay

$25,530

Average discount available for prompt cash payment at this facility.

Insurance Median

$27,503

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: $25,530 (181%)

Insurance Median: $27,503 (195%)

Cash: $25,530 (181% of Medicare)

Ins. Median: $27,503 (195% 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	$11,589 - $43,231	82%
Aetna	$20,948 - $46,211	148%
Amerihealth	$20,948	148%
Ubh	$20,948	148%
UnitedHealthcare	$20,948 - $34,165	148%
Wellpoint Amerigroup	$20,948	148%
Wellcare	$21,576 - $34,467	153%
Clover Health	$21,786	154%
Tricare	$21,936	155%
Humana	$25,531	181%
Medicare (plans)	$25,531	181%
Curana	$26,807	190%
Naphcare	$32,469	230%
Cigna	$32,906	233%
Employer Direct Healthcare	$33,190	235%
Fairprice Healthcare Holdings - Fphh	$40,849	289%
Coventry	$43,403	307%

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 $25,530.
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 Saint Michael's 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.