CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Margaretville Memorial Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $6,872
Cash Discount Price: $15,279
vs. Medicare Baseline: 0.49x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Margaretville Memorial Hospital is $6,872. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15,279. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 0.49x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.

Cash / Self-Pay

$15,279

Average discount available for prompt cash payment at this facility.

Insurance Median

$6,872

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: $15,279 (108%)

Insurance Median: $6,872 (49%)

Cash: $15,279 (108% of Medicare)

Ins. Median: $6,872 (49% 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
Todays Options	$2,654 - $2,920	19%
Aetna	$3,395 - $55,743	24%
Blue Cross Blue Shield	$3,395 - $66,090	24%
Cdphp	$3,395 - $3,735	24%
Hamaspik	$3,395	24%
Magnacare	$3,395 - $6,872	24%
Mvp	$3,395 - $45,035	24%
Non Contracted	$3,395	24%
UnitedHealthcare	$3,395 - $52,508	24%
Wellcare	$3,395	24%
Health First	$3,633	26%
Emblem	$46,283 - $79,964	328%
Oxford	$47,259 - $52,508	335%

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 $15,279.
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 Margaretville Memorial Hospital 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.