CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: St Charles Madras

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $5,338
Cash Discount Price: $22,398
vs. Medicare Baseline: 0.38x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at St Charles Madras is $5,338. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $22,398. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 0.38x the Medicare baseline. Located in 470 Ne A Street, Madras, OR.

Cash / Self-Pay

$22,398

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,338

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: $22,398 (159%)

Insurance Median: $5,338 (38%)

Cash: $22,398 (159% of Medicare)

Ins. Median: $5,338 (38% 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	$5,338	38%
Ageright Advantage [142]	$5,338	38%
Champ Va [700]	$5,338	38%
Cigna	$5,338	38%
Covid19 Hrsa Uninsured Testing And Treatment Fund	$5,338	38%
Devoted Health Inc [145]	$5,338	38%
Health Market Care Assured [134]	$5,338	38%
Health Net Med Adv [135]	$5,338	38%
Humana	$5,338	38%
Indian Health [704]	$5,338	38%
Kaiser Permanente Med Adv [136]	$5,338	38%
Law Enforcement [701]	$5,338	38%
Medicare (plans)	$5,338 - $6,192	38%
Samaritan Health Plan Med Adv [141]	$5,338	38%
Unicare [133]	$5,338	38%
UnitedHealthcare	$5,338	38%
Veterans [706]	$5,338	38%
Wellcare [132]	$5,338	38%
Blue Cross Blue Shield	$5,872	42%
Rx Internal [4100003]	$41,769	296%

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 $22,398.
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 St Charles Madras 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.