CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Ascension St John Medical Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $12,047
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.85x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Ascension St John Medical Center is $12,047. 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 0.85x the Medicare baseline. Located in 1923 South Utica Avenue, Tulsa, OK.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$12,047

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: $12,047 (85%)

Ins. Median: $12,047 (85% 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
Communitycare (Select)	$2,735 - $18,071	19%
Communitycare (Standard)	$2,735 - $13,252	19%
Pcc	$6,089	43%
Aetna	$6,781 - $11,033	48%
Medica	$8,300	59%
Cigna	$8,761	62%
First Health	$11,000	78%
Champva	$12,047	85%
Community Care - St John Network Senior - Govt	$12,047	85%
Communitycare Senior	$12,047	85%
Life Pace	$12,047	85%
Longevity Health Plan Of Oklahoma	$12,047	85%
Medicare (plans)	$12,047	85%
UnitedHealthcare	$12,047 - $16,493	85%
Va Community Care Network	$12,047	85%
Veterans Administration	$12,047	85%
Humana	$12,168	86%
Blue Cross Blue Shield	$12,650	90%
Community Care (Select) 7/1/13	$14,457	102%
Ccl&H	$15,661	111%
Smarthealth	$16,866	119%
Community Care Smarthealth	$18,071	128%
Connect Health Benefit	$24,094	171%
Evolutions	$24,094	171%
Kempton Group Administrators	$27,106	192%

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 Ascension St John Medical Center 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.