CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Good Samaritan Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $23,670
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.68x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Good Samaritan Hospital is $23,670. 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 1.68x the Medicare baseline. Located in 375 Dixmyth Avenue, Cincinnati, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$23,670

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: $23,670 (168%)

Ins. Median: $23,670 (168% 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
Aetna	$16,861 - $33,978	119%
Blue Cross Blue Shield	$16,861 - $38,438	119%
Caresource	$16,861	119%
Essence Healthcare	$16,861	119%
Humana	$16,861	119%
Medigold	$16,861	119%
Molina	$16,861	119%
UnitedHealthcare	$16,861 - $36,453	119%
Medical Mutual Of Ohio	$17,198 - $40,740	122%
Buckeye	$17,367 - $24,449	123%
Wellcare	$17,367	123%
Oscar	$22,399	159%
Cigna	$29,755	211%
Imagine Health	$40,438	286%
Custom Design Benefits	$41,478 - $43,670	294%
Medben	$46,200 - $48,560	327%

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 $X.
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 Good Samaritan 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.