CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Good Samaritan Hospital Medical Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 871
  • Insurance Median: $18,445
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.31x Medicare
The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Good Samaritan Hospital Medical Center is $18,445. 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 1.31x the Medicare baseline. Located in 1000 Montauk Highway, West Islip, NY.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$18,445

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: $18,445 (131%)
Ins. Median: $18,445 (131% 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 $7,286 - $10,185 52%
Us Family Health Plan $13,295 94%
Blue Cross Blue Shield $17,409 - $53,571 123%
Centerlight Healthcare $17,409 123%
Centers Plan For Healthy Living $17,765 126%
Elderplan Inc. $17,765 126%
Emblem Health $17,765 - $46,207 126%
Fidelis Care New York $17,765 126%
Healthspring $17,765 126%
Independent Health $17,765 126%
Liberty Health $17,765 126%
Longevity Health Plan $17,765 126%
Medicare (plans) $17,765 - $18,653 126%
Mvp Health Plans $17,765 - $37,521 126%
Orthonet - Uniformed Services Family Health Plan $17,765 126%
Pmc $17,765 126%
Senior Whole Health $17,765 126%
Tricare $17,765 126%
UnitedHealthcare $17,765 - $53,571 126%
Universal Healthcare $17,765 126%
Veterans Affairs $17,765 126%
Zadroga $17,765 126%
Health First $17,942 - $39,970 127%
Humana $18,120 128%
Agewell New York $18,386 130%
Aetna $18,445 - $44,451 131%
Health Plus $18,445 131%
Wellcare Health Plan Inc $18,475 131%
Partners Health Plan $18,653 132%
Centivo $32,541 - $37,521 231%
Local 1199 $35,889 254%
Apwu $37,521 266%
Cigna $37,521 266%
Daniel H Cook $37,521 266%
Nalc $37,521 266%
Samba $37,521 266%
Mail Handlers Benefit Plan $44,451 315%
Meritain Health $44,451 315%
Nippon Life Insurance Company Of America $44,451 315%
Salvation Army $44,451 315%
American Plan Administrators $46,207 327%
Amerihealth Administrators $46,207 327%
Benefit Services $46,207 327%
Ghi Cbp Ny City Employee Alternate $46,207 327%
International Benefit Administrator $46,207 327%
Ultra Benefits Inc. $46,207 327%
Surest $48,009 340%
Self Pay $53,571 379%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1000 Montauk Highway, West Islip, NY 11795
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals