CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Holy Cross Hospital - Salt Lake

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $23,383
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.66x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Holy Cross Hospital - Salt Lake is $23,383. 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 1.66x the Medicare baseline. Located in 1050 East South Temple, Salt Lake City, UT.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$23,383

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: $23,383 (166%)

Ins. Median: $23,383 (166% 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
Molina	$14,998	106%
Humana	$16,883	120%
Medicare (plans)	$16,883	120%
Denver Health	$17,559	124%
Health Choice	$17,559	124%
Medicaid / KanCare	$17,559	124%
Rocky Mountain Health Plan	$17,559	124%
Uuhp	$17,559 - $27,027	124%
Motivhealth	$22,396	159%
Deseret Mutual Benefit Administrators	$23,383	166%
Pehp	$23,535 - $30,752	167%
Employer Direct Healthcare	$24,635	175%
Cigna	$28,997 - $48,170	205%
UnitedHealthcare	$30,631	217%
Blue Cross Blue Shield	$31,221	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 Holy Cross Hospital - Salt Lake 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.