CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Texas Health Presbyterian Hospital Flower Mound

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $22,015
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.56x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Texas Health Presbyterian Hospital Flower Mound is $22,015. 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 1.56x the Medicare baseline. Located in 4400 Long Prairie Road, Flower Mound, TX.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$22,015

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: $22,015 (156%)

Ins. Median: $22,015 (156% 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
American Health	$14,954	106%
Blue Cross Blue Shield	$14,954 - $142,127	106%
Healthspring	$15,253	108%
Humana	$15,552	110%
Amerigroup	$15,701	111%
Molina	$15,701	111%
Superior Wellcare	$15,701 - $16,449	111%
UnitedHealthcare	$16,599 - $68,365	118%
Aetna	$33,362 - $44,481	236%
Fort Worth Firefighters	$38,600	273%
Cigna	$45,431 - $83,064	322%

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 Texas Health Presbyterian Hospital Flower Mound 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.