CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: St Mary Medical Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $27,822
Cash Discount Price: $25,456
vs. Medicare Baseline: 1.97x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at St Mary Medical Center is $27,822. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25,456. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.97x the Medicare baseline. Located in Langhorne-Newtown Rd, Langhorne, PA.

Cash / Self-Pay

$25,456

Average discount available for prompt cash payment at this facility.

Insurance Median

$27,822

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: $25,456 (180%)

Insurance Median: $27,822 (197%)

Cash: $25,456 (180% of Medicare)

Ins. Median: $27,822 (197% 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
Geha	$4,581	32%
UnitedHealthcare	$4,581	32%
Pace-Trinity Health	$13,911	99%
Cigna	$15,602 - $39,619	111%
Blue Cross Blue Shield	$15,609 - $44,222	111%
Align Senior Care	$15,766	112%
Medicare (plans)	$15,843 - $27,822	112%
Aetna	$16,359 - $43,749	116%
Health America Advantra	$16,539	117%
Jefferson Health Plan Commercial	$26,694	189%
Ambetter / Centene	$27,590	195%
Oscar	$27,822	197%
Prime Healthcare	$27,822	197%
Homestead Health Plans Woods Center	$30,141	214%
Amerihealth	$30,721	218%
Blue Shield - Ca	$30,721	218%
Blue Shield - Id (Regence)	$30,721	218%
Blue Shield - Ny Highmark Western	$30,721	218%
Blue Shield - Wa (Regence)	$30,721	218%
Blue Shield - Pa (Highmark)	$33,436	237%
Group Pension Administrators	$36,935	262%
Reedman Toll	$36,935	262%
Upmc Health Plan	$39,619	281%
Webtpa	$39,619	281%
Meritain	$43,749	310%

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 $25,456.
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 Mary Medical Center 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.