CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: St Catherine of Siena Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 871
  • Insurance Median: $17,319
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.23x Medicare
The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at St Catherine of Siena Hospital is $17,319. 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 1.23x the Medicare baseline. Located in 50 Route 25A, Smithtown, NY.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$17,319

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: $17,319 (123%)
Ins. Median: $17,319 (123% 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 $16,640 - $46,419 118%
Centerlight Healthcare $16,640 118%
Aetna $16,979 - $40,294 120%
Beacon Health Options $16,979 - $23,771 120%
Beacon Health Strategies $16,979 - $23,771 120%
Centers Plan For Healthy Living $16,979 120%
Elderplan Inc. $16,979 120%
Emblem Health $16,979 - $44,889 120%
Fidelis Care New York $16,979 120%
Health Plus $16,979 120%
Healthspring $16,979 120%
Independent Health $16,979 120%
Liberty Health $16,979 120%
Longevity Health Plan $16,979 120%
Medicare (plans) $16,979 - $17,828 120%
Mvp Health Plans $16,979 - $35,377 120%
Orthonet - Uniformed Services Family Health Plan $16,979 120%
Pmc $16,979 120%
Senior Whole Health $16,979 120%
Tricare $16,979 120%
UnitedHealthcare $16,979 - $46,419 120%
Universal Healthcare $16,979 120%
Veterans Affairs $16,979 120%
Zadroga $16,979 120%
Health First $17,149 - $38,203 121%
Humana $17,319 123%
Agewell New York $17,573 124%
Wellcare Health Plan Inc $17,658 125%
Partners Health Plan $17,828 126%
Centivo $29,504 - $35,377 209%
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 $40,294 285%
Meritain Health $40,294 285%
Nippon Life Insurance Company Of America $40,294 285%
Salvation Army $40,294 285%
Surest $43,721 310%
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%
Self Pay $46,419 329%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 50 Route 25A, Smithtown, NY 11787
  • CMS Rating: ★★★★★
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals