CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Montefiore New Rochelle Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $17,253
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Montefiore New Rochelle Hospital is $17,253. 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 1.22x the Medicare baseline. Located in 16 Guion Place, New Rochelle, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,253

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: $17,253 (122%)

Ins. Median: $17,253 (122% 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
Empire	$15,684	111%
Fidelis	$15,684	111%
Healthfirst	$15,684	111%
Metroplus	$15,684 - $20,390	111%
UnitedHealthcare	$15,684 - $57,282	111%
Villagecaremax	$15,684	111%
Wellcare	$15,998	113%
Centerlight	$16,155	114%
Emblem	$16,155 - $138,405	114%
Humana	$16,155	114%
Amidacare	$16,469	117%
Vnsny Choice	$16,469	117%
Hamaspik	$17,253	122%
Partners_Health_Plan	$17,253	122%
Molina Healthcare Of Ny Affinity	$21,645	153%
Oscar	$55,714	395%
Mvp	$59,128	419%
Cigna	$60,615	429%
Aetna	$67,095 - $75,052	475%
Centivo	$86,518	613%
Northwell	$94,424	669%

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 Montefiore New Rochelle Hospital 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.