CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Queens Hospital Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $43,030
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.05x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Queens Hospital Center is $43,030. 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 3.05x the Medicare baseline. Located in 82-68 164Th Street, Jamaica, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$43,030

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: $43,030 (305%)

Ins. Median: $43,030 (305% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 305% of the Medicare baseline (a markup of 205%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Oscar	$17,861	127%
Local 1199	$24,632	174%
Oxford	$31,970 - $43,030	226%
Cigna	$36,782	261%
Emblem	$37,521 - $43,030	266%
Healthfirst	$40,018	283%
Aetna	$40,415 - $43,030	286%
United	$40,702 - $47,118	288%
Centerlight	$42,170	299%
Blue Cross Blue Shield	$43,030	305%
Elderplan	$43,030	305%
Hamaspik	$43,030	305%
Senior Whole Health	$43,030 - $43,364	305%
Vaccn	$43,030	305%
Vnsny	$43,030	305%
Wellcare	$43,676	309%
Metroplus	$44,321	314%
Centers Plan For Healthy Living	$44,751	317%
Villagecare Max	$48,624	344%
Multiplan	$49,147	348%
Fidelis	$50,776 - $61,103	360%

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 Queens Hospital 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.