CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Roxborough Memorial Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $18,889
Cash Discount Price: $18,373
vs. Medicare Baseline: 1.34x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Roxborough Memorial Hospital is $18,889. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18,373. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.34x the Medicare baseline. Located in 5800 Ridge Ave, Philadelphia, PA.

Cash / Self-Pay

$18,373

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,889

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: $18,373 (130%)

Insurance Median: $18,889 (134%)

Cash: $18,373 (130% of Medicare)

Ins. Median: $18,889 (134% 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
Humana	$13,287	94%
Blue Cross Blue Shield	$15,463 - $22,806	110%
Health Partners Plan	$15,463 - $22,533	110%
Pa Health & Wellness	$15,463 - $22,049	110%
Ubh	$15,463 - $18,374	110%
UnitedHealthcare	$15,463 - $18,889	110%
Keystone	$16,082	114%
Medicare (plans)	$16,236 - $18,374	115%
Tricare	$17,300	123%
Providers Partner Health Plan	$18,925	134%
Spartan	$19,293	137%
Luminary	$19,452	138%
Auto Insurance	$20,211	143%
Keenan	$22,050	156%
Employer Direct Healthcare	$23,886	169%
Cigna	$25,682	182%
Naphcare	$28,480	202%
Highmark	$33,645	238%

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 $18,373.
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 Roxborough 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.