CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Wayne Memorial Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $16,430
Cash Discount Price: $26,958
vs. Medicare Baseline: 1.16x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Wayne Memorial Hospital is $16,430. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $26,958. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.16x the Medicare baseline. Located in 601 Park Street, Honesdale, PA.

Cash / Self-Pay

$26,958

Average discount available for prompt cash payment at this facility.

Insurance Median

$16,430

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: $26,958 (191%)

Insurance Median: $16,430 (116%)

Cash: $26,958 (191% of Medicare)

Ins. Median: $16,430 (116% 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
Aarp	$12,626	89%
UnitedHealthcare	$12,626 - $16,430	89%
Upmc	$12,857 - $33,841	91%
Aetna	$14,569	103%
Blue Cross Blue Shield	$16,430 - $30,691	116%
Humana	$16,430 - $16,594	116%
Mvp	$16,430	116%
Tricare	$16,430	116%
Ambetter / Centene	$17,416	123%
Pa Health & Wellness	$17,416	123%
Wellpath	$21,359 - $30,396	151%
Cigna	$27,778	197%

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 $26,958.
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 Wayne 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.