CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Pennsylvania Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $25,983
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.84x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Pennsylvania Hospital is $25,983. 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 1.84x the Medicare baseline. Located in 800 Spruce Street, Philadelphia, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,983

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: $25,983 (184%)

Ins. Median: $25,983 (184% 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
Workers Compensation	$3,209	23%
UnitedHealthcare	$3,308 - $42,751	23%
Penn Life (Living Independently For Elders)	$16,097	114%
Blue Cross Blue Shield	$16,282 - $42,854	115%
Medicare (plans)	$16,282 - $18,592	115%
Upmc	$16,282	115%
Ibc	$16,635	118%
Cigna	$16,770 - $40,948	119%
Geisinger Health Plan	$16,770 - $58,556	119%
Health Partners	$16,770	119%
Humana	$16,770	119%
Keystone First	$17,096	121%
Pa Health And Wellness	$17,096 - $30,677	121%
Aetna	$17,259 - $33,671	122%
Clover Health Plan	$17,259	122%
Gateway Health Plan	$17,750	126%
Philadelphia Va Medical Center	$18,592	132%
Us Family Health Plan	$22,011	156%
Ibc Commercial Hpn	$25,544	181%
Elap	$26,400	187%
Claims Watcher	$29,747 - $33,465	211%
Oscar Health Plan	$31,606	224%
Centivo	$33,465	237%
Elap Services	$34,581	245%
Keystone Hmo Proactive	$34,910	247%
Highmark	$36,888	261%
Olympus	$40,704	288%
Pgm - Embassy Of Qatar	$40,877	290%
Pgm - Embassy Of The United Emirates/Ipc	$44,022	312%
Qualcare	$44,886	318%
Penn Global Medicine	$49,268	349%

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 Pennsylvania 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.