CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: St Anthony Community Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 871
  • Insurance Median: $26,463
  • Cash Discount Price: $26,663
  • vs. Medicare Baseline: 1.87x Medicare
The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at St Anthony Community Hospital is $26,463. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $26,663. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.87x the Medicare baseline. Located in 15 Maple Avenue -19, Warwick, NY.
Cash / Self-Pay
$26,663

Average discount available for prompt cash payment at this facility.

Insurance Median
$26,463

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: $26,663 (189%)
Insurance Median: $26,463 (187%)
Cash: $26,663 (189% of Medicare)
Ins. Median: $26,463 (187% 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.

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%
Aetna $17,775 - $56,726 126%
Blue Cross Blue Shield $17,775 126%
Cdphp $17,775 126%
Emblem $17,775 - $65,119 126%
Fidelis $17,775 126%
Geisinger $17,775 - $40,350 126%
Hamaspik $17,775 126%
Magnacare $17,775 - $74,656 126%
Mvp $17,775 - $63,775 126%
Non Contracted $17,775 126%
Oxford $17,775 - $52,845 126%
Partners Health Plan $17,775 126%
UnitedHealthcare $17,775 - $52,845 126%
Wellcare $17,775 126%
Tricare $18,064 128%
Health First $19,020 135%
World Trade Center $26,463 187%
Cigna $60,806 431%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 15 Maple Avenue -19, Warwick, NY 10990
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals