CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Healthbridge Childrens's Hospital of Houston

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $245,433
Cash Discount Price: Unavailable
vs. Medicare Baseline: 17.39x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Healthbridge Childrens's Hospital of Houston is $245,433. 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 17.39x the Medicare baseline. Located in 2929 Woodland Park Drive, Houston, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$245,433

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: $245,433 (1739%)

Ins. Median: $245,433 (1739% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1739% of the Medicare baseline (a markup of 1639%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Dps Bailey - All Plans	$62,415	442%
Unicare - All Plans	$178,500	1264%
Beech Street - All Plans	$178,792	1267%
Phcs - All Plans	$181,412	1285%
Blue Cross Blue Shield	$188,100 - $213,750	1332%
Medicaid / KanCare	$208,468 - $337,766	1477%
Mhealth - All Plans	$212,095	1502%
Humana	$227,058	1608%
Superior - All Plans	$245,433	1739%
Aetna	$245,727	1741%
Cigna	$249,318	1766%
Texas True Choice - All Plans	$249,904	1770%
Point Comfort - All Plans	$256,500	1817%
Healthsmart - All Plans	$273,600	1938%
UnitedHealthcare	$273,600	1938%
Accountable Hp Of America - All Plans	$394,060	2791%
America Choice Prov Netw - All Plans	$450,354	3190%

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 Healthbridge Childrens's Hospital of Houston 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.