CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Saint Mary's Regional Medical Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $19,981
Cash Discount Price: $16,311
vs. Medicare Baseline: 1.42x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Saint Mary's Regional Medical Center is $19,981. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16,311. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.42x the Medicare baseline. Located in 235 W 6Th St, Reno, NV.

Cash / Self-Pay

$16,311

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,981

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: $16,311 (116%)

Insurance Median: $19,981 (142%)

Cash: $16,311 (116% of Medicare)

Ins. Median: $19,981 (142% 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
Aetna	$16,311	116%
Blue Cross Blue Shield	$16,311	116%
Health Plan Of Nevada	$16,311	116%
Medicare (plans)	$16,311	116%
Molina Healthcare Of Nv	$16,311	116%
Saint Mary Health Plan	$16,311 - $18,758	116%
Sierra	$16,311	116%
Silver Summit	$16,311 - $25,283	116%
Tricare	$16,311 - $16,860	116%
Triwest	$16,311	116%
Alignment	$16,638	118%
UnitedHealthcare	$16,801	119%
Pam	$18,758	133%
Employer Direct	$21,205	150%
Home Town Test	$22,836	162%
Naphcare	$22,836	162%
Asserta Health	$24,467	173%
Imperial Insurance Company	$24,467 - $30,176	173%
Occunet	$24,467	173%
Nevada Health Partners	$25,854	183%
National Healthcare Solutions, Inc	$26,098	185%
Custom Ink	$27,240	193%
Nv Preferred	$27,341 - $34,701	194%
6 Degrees	$29,034	206%

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 $16,311.
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 Mary's Regional 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.