CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Rio Grande Regional Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $20,111
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.42x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Rio Grande Regional Hospital is $20,111. 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 1.42x the Medicare baseline. Located in 101 E Ridge Rd, McAllen, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,111

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: $20,111 (142%)

Ins. Median: $20,111 (142% 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
Oscar	$2,014 - $22,154	14%
First Health	$2,258 - $2,346	16%
Blue Cross Blue Shield	$2,317 - $32,140	16%
Curative Administrators	$2,717 - $31,873	19%
Aetna	$2,958 - $19,849	21%
United	$3,060 - $19,889	22%
Allegian Health	$16,317 - $20,396	116%
Humana	$19,206 - $29,460	136%
Cigna	$19,910 - $32,721	141%
Texas Healthcare Foundation	$20,111	142%
Triwest Healthcare Alliance	$20,111	142%
Wellmed	$20,191	143%
Provider Partners Health Plan Of Texas	$20,513	145%
American Health Plan	$21,116	150%
Physicians Health Choice	$21,116	150%
Prominence Health	$21,116	150%
Superior Health Plan	$21,116	150%
Texas Independent Health Plan	$21,116	150%
Shared Health	$21,518	152%
Universal Health Care	$21,719	154%
Molina	$21,921	155%
Independent Medical System	$27,069	192%
Corvel Corporation	$28,471	202%
Focus Healthcare	$28,758	204%
Omni Healthcare	$30,196	214%
Molina Healthcare	$30,783	218%
Superior	$31,171	221%

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 Rio Grande Regional 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.