CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Samaritan Hospital of Troy, New York

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $21,213
Cash Discount Price: $26,084
vs. Medicare Baseline: 1.50x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Samaritan Hospital of Troy, New York is $21,213. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $26,084. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.50x the Medicare baseline. Located in 2215 Burdett Avenue, Troy, NY.

Cash / Self-Pay

$26,084

Average discount available for prompt cash payment at this facility.

Insurance Median

$21,213

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: $26,084 (185%)

Insurance Median: $21,213 (150%)

Cash: $26,084 (185% of Medicare)

Ins. Median: $21,213 (150% 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
Wellpath	$3,000	21%
Blue Cross Blue Shield	$18,585 - $18,964	132%
Medicare (plans)	$18,956 - $21,187	134%
Eddy Seniorcare Pace	$18,964	134%
Secure Horizons Ma Pffs	$19,328	137%
UnitedHealthcare	$19,328 - $69,641	137%
Aetna	$20,072 - $41,738	142%
Medicaid / KanCare	$20,102	142%
Hudson Headwaters Pace	$20,481	145%
Nascentia Health Plus	$21,240	150%
Fidelis Care	$34,135	242%
1199 National Benefit Fund	$41,738	296%
Allied Benefit Systems	$41,738	296%
Asr Health Benefits	$41,738	296%
Christian Brother Services	$41,738	296%
Geha	$41,738	296%
Lucent Health	$41,738	296%
Luminare Health	$41,738	296%
Medical Mutual	$41,738	296%
Meritain	$41,738	296%
Trustmark Small Business Benefits	$41,738	296%
Capital District Physicians Health Plan	$53,714	380%
Emblem Health	$53,986	382%
Nova	$53,986	382%
Harvard Pilgrim Healthcare	$69,641	493%

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 $26,084.
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 Samaritan Hospital of Troy, New York 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.