CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: St Charles Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 871
  • Insurance Median: $18,654
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.32x Medicare
The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at St Charles Hospital is $18,654. 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 1.32x the Medicare baseline. Located in 200 Belle Terre Road, Port Jefferson, NY.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$18,654

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: $18,654 (132%)
Ins. Median: $18,654 (132% 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
Brighton $6,454 - $9,258 46%
Us Family Health Plan $13,295 94%
Blue Cross Blue Shield $17,923 - $45,542 127%
Centerlight Healthcare $17,923 127%
Emblem Health $18,157 - $44,889 129%
Beacon Health Options $18,288 - $25,604 130%
Beacon Health Strategies $18,288 - $25,604 130%
Centers Plan For Healthy Living $18,288 130%
Elderplan Inc. $18,288 130%
Fidelis Care New York $18,288 130%
Healthspring $18,288 130%
Independent Health $18,288 130%
Liberty Health $18,288 130%
Longevity Health Plan $18,288 130%
Medicare (plans) $18,288 - $19,203 130%
Mvp Health Plans $18,288 - $35,377 130%
Orthonet - Uniformed Services Family Health Plan $18,288 130%
Pmc $18,288 130%
Senior Whole Health $18,288 130%
Tricare $18,288 130%
UnitedHealthcare $18,288 - $45,542 130%
Universal Healthcare $18,288 130%
Veterans Affairs $18,288 130%
Zadroga $18,288 130%
Aetna $18,442 - $40,863 131%
Health Plus $18,442 131%
Health First $18,471 - $41,149 131%
Humana $18,654 132%
Agewell New York $18,928 134%
Wellcare Health Plan Inc $19,020 135%
Partners Health Plan $19,203 136%
Centivo $29,912 - $35,377 212%
Local 1199 $31,407 222%
Apwu $35,377 251%
Cigna $35,377 251%
Daniel H Cook $35,377 251%
Nalc $35,377 251%
Samba $35,377 251%
Mail Handlers Benefit Plan $40,863 289%
Meritain Health $40,863 289%
Nippon Life Insurance Company Of America $40,863 289%
Salvation Army $40,863 289%
American Plan Administrators $44,889 318%
Amerihealth Administrators $44,889 318%
Benefit Services $44,889 318%
Ghi Cbp Ny City Employee Alternate $44,889 318%
International Benefit Administrator $44,889 318%
Ultra Benefits Inc. $44,889 318%
Surest $45,472 322%
Self Pay $45,542 323%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 200 Belle Terre Road, Port Jefferson, NY 11777
  • CMS Rating: ★★★★★
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals