CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Allegheny Valley Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $14,326
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Allegheny Valley Hospital is $14,326. 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 1.01x the Medicare baseline. Located in 1301 Carlisle St, Natrona, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,326

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: $14,326 (101%)

Ins. Median: $14,326 (101% 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
Geisinger	$2,734 - $14,058	19%
Highmark	$8,429 - $28,838	60%
Life Pittsburgh	$13,389	95%
The Health Plan Of The Upper Ohio Valley	$13,389 - $14,728	95%
UnitedHealthcare	$13,389 - $14,460	95%
Aetna	$13,924 - $30,016	99%
Amerihealth	$14,058	100%
Highmark Wholecare	$14,192	101%
Humana	$14,192	101%
Medicare (plans)	$14,192 - $15,531	101%
Cigna	$14,326 - $31,597	101%
Jefferson Health Plans	$14,460	102%
Molina	$14,594	103%
American Health Plans	$14,728	104%
Martin'S Point	$14,971	106%
Medical Mutual	$31,597	224%

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 Allegheny Valley 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.