CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Mountain View Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $19,584
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.39x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Mountain View Hospital is $19,584. 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 1.39x the Medicare baseline. Located in 1000 East 100 North, Payson, UT.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,584

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: $19,584 (139%)

Ins. Median: $19,584 (139% 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
Aetna	$3,564 - $29,619	25%
Bright Health	$12,671	90%
Humana	$14,351 - $29,669	102%
Coventry Altius	$14,650	104%
Cigna	$14,949 - $55,225	106%
Molina Healthcare	$14,949 - $17,646	106%
State Of Utah	$14,949	106%
Triwest Healthcare Alliance	$14,949	106%
University Of Ut	$14,949	106%
Veteran'S Administration	$14,949	106%
Molina	$15,065	107%
Blue Cross Blue Shield	$15,098	107%
Sterling Life Insurance	$15,995	113%
Universal Healthcare	$16,294	115%
Elap	$17,425	123%
Health Choice	$17,558	124%
Hosp Uncompensated Care	$17,558	124%
Regence	$18,554 - $30,792	131%
Angle Insurance	$21,224	150%
University Of Utah	$23,637 - $31,123	167%
Pehp	$29,123 - $35,995	206%
Motivhealth	$33,965	241%
Dmba (Deseret Mutual Benefit Admin)	$36,893	261%
Imagine Health Wise	$37,576	266%

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 Mountain View 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.