CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Good Samaritan Hospital of Suffern

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $27,218
Cash Discount Price: $27,513
vs. Medicare Baseline: 1.93x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Good Samaritan Hospital of Suffern is $27,218. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $27,513. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.93x the Medicare baseline. Located in 255 Lafayette Avenue, Suffern, NY.

Cash / Self-Pay

$27,513

Average discount available for prompt cash payment at this facility.

Insurance Median

$27,218

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: $27,513 (195%)

Insurance Median: $27,218 (193%)

Cash: $27,513 (195% of Medicare)

Ins. Median: $27,218 (193% 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
First Health	$1,664	12%
Multiplan	$5,836	41%
Tricare	$18,064	128%
Aetna	$18,342 - $56,726	130%
Blue Cross Blue Shield	$18,342	130%
Cdphp	$18,342	130%
Emblem	$18,342 - $79,964	130%
Fidelis	$18,342	130%
Geisinger	$18,342 - $41,637	130%
Hamaspik	$18,342	130%
Magnacare	$18,342 - $74,656	130%
Mvp	$18,342 - $63,775	130%
Non Contracted	$18,342	130%
Oxford	$18,342 - $52,845	130%
Partners Health Plan	$18,342	130%
UnitedHealthcare	$18,342 - $52,845	130%
Wellcare	$18,342	130%
Health First	$19,626	139%
World Trade Center	$27,218	193%
Cigna	$60,806	431%

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 $27,513.
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 Good Samaritan Hospital of Suffern 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.