CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Garnet Health Medical Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $20,870
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.48x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Garnet Health Medical Center is $20,870. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.48x the Medicare baseline. Located in 707 East Main Street, Middletown, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,870

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%)

Insurance Median: $20,870 (148%)

Ins. Median: $20,870 (148% 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	$20,870 - $58,275	148%
Blue Cross Blue Shield	$20,870	148%
Cdphp	$20,870 - $71,707	148%
Cigna	$20,870 - $58,681	148%
Emblem Health	$20,870 - $71,167	148%
Geisinger Health Plan	$20,870 - $46,957	148%
Health First	$20,870	148%
Humana	$20,870	148%
Mvp	$20,870	148%
Prime Health Services	$20,870	148%
UnitedHealthcare	$20,870 - $60,357	148%
Upmc	$20,870	148%
Wellcare	$21,183	150%
Fidelis	$21,287	151%
Northwell Direct	$42,735	303%
Local 1199	$58,275	413%
Magnacare	$75,155	532%

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 $X.
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 Garnet Health 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.