CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: St Clair Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $24,817
Cash Discount Price: $14,222
vs. Medicare Baseline: 1.76x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at St Clair Hospital is $24,817. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $14,222. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.76x the Medicare baseline. Located in 1000 Bower Hill Road, Pittsburgh, PA.

Cash / Self-Pay

$14,222

Average discount available for prompt cash payment at this facility.

Insurance Median

$24,817

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: $14,222 (101%)

Insurance Median: $24,817 (176%)

Cash: $14,222 (101% of Medicare)

Ins. Median: $24,817 (176% 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
Highmark	$12,378 - $27,542	88%
Amerihealth	$13,731	97%
Humana	$13,731	97%
UnitedHealthcare	$13,731 - $24,817	97%
Pa Health And Wellness	$14,005	99%
Aetna	$14,143 - $27,549	100%
The Health Plan	$14,417 - $30,894	102%
Cigna	$14,554 - $26,224	103%
Geisinger	$14,554	103%
Upmc	$14,614 - $20,991	104%
Health Partners	$14,692	104%

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 $14,222.
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 Clair 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.