CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Montefiore St Luke's Cornwall

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $16,782
Cash Discount Price: $20,364
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Montefiore St Luke's Cornwall is $16,782. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $20,364. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.19x the Medicare baseline. Located in 70 Dubois Street, Newburgh, NY.

Cash / Self-Pay

$20,364

Average discount available for prompt cash payment at this facility.

Insurance Median

$16,782

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: $20,364 (144%)

Insurance Median: $16,782 (119%)

Cash: $20,364 (144% of Medicare)

Ins. Median: $16,782 (119% 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
UnitedHealthcare	$15,371 - $57,729	109%
Aetna	$15,528	110%
Affinity	$15,684 - $16,782	111%
Blue Cross Blue Shield	$15,684	111%
Cdphp	$15,684	111%
Fidelis	$15,684	111%
Healthfirst	$15,684	111%
Hudson Valley	$15,684	111%
Mediblue	$15,684	111%
Oscar	$15,684 - $55,714	111%
Point Comfort	$15,684	111%
Centerlight	$16,155	114%
Emblem	$16,155 - $156,982	114%
Humana	$16,155	114%
Wellcare	$16,155	114%
Vnsny Choice	$16,469	117%
Hamaspik	$17,253	122%
Magnacare	$18,446	131%
Cigna	$58,437 - $64,931	414%
Centivo	$92,264	654%
Northwell	$93,372	661%

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 $20,364.
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 St Luke's Cornwall 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.