CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Starr Regional Medical Center Athens

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $14,671
Cash Discount Price: $10,577
vs. Medicare Baseline: 1.04x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Starr Regional Medical Center Athens is $14,671. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,577. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.04x the Medicare baseline. Located in 1114 W Madison Ave, Athens, TN.

Cash / Self-Pay

$10,577

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,671

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: $10,577 (75%)

Insurance Median: $14,671 (104%)

Cash: $10,577 (75% of Medicare)

Ins. Median: $14,671 (104% 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
Aetna	$1,811 - $14,671	13%
UnitedHealthcare	$3,234 - $14,671	23%
Humana	$3,765 - $14,965	27%
Tricare	$12,838	91%
Advantra	$14,671	104%
Blue Cross Blue Shield	$14,671 - $15,975	104%
Cigna	$14,671	104%
Medicare (plans)	$14,671	104%
Pyramid	$14,671	104%
Secure Horizons	$14,671	104%
Tennessee Rural Health Improvement Association	$14,827	105%
Devoted Health	$15,112	107%
Healthspring	$15,405	109%
Signature Health	$15,552	110%
Peach State Health Plan	$44,014	312%

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 $10,577.
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 Starr Regional Medical Center Athens 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.