CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Baylor Scott and White Medical Center Lake Pointe

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $17,500
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.24x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Baylor Scott and White Medical Center Lake Pointe is $17,500. 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 1.24x the Medicare baseline. Located in 6800 Scenic Dr, Rowlett, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,500

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: $17,500 (124%)

Ins. Median: $17,500 (124% 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	$2,778 - $15,217	20%
Healthsmart	$2,804 - $26,755	20%
Baylor Scott & White Health Plan	$14,457 - $27,391	102%
Triwest	$15,217	108%
Wellpoint (Fka Amerigroup)	$15,674	111%
Corvel	$15,942	113%
Prime Health Services	$15,942	113%
American Health Plan	$15,978	113%
Blue Cross Blue Shield	$15,978 - $28,742	113%
Healthspring	$15,978	113%
Molina	$15,978	113%
Procare Advantage	$15,978	113%
Superior Health Plan	$15,978	113%
University Of Mary Hardin-Baylor	$16,884	120%
UnitedHealthcare	$17,500 - $44,736	124%
Cigna	$19,597 - $23,055	139%
Employers Health Network	$20,181	143%
Aetna	$27,457	194%
Ambetter / Centene	$34,391	244%

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 Baylor Scott and White Medical Center Lake Pointe 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.