CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Lone Peak Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $21,224
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.50x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Lone Peak Hospital is $21,224. 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 1.50x the Medicare baseline. Located in 11925 South State Street, Draper, UT.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$21,224

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: $21,224 (150%)

Ins. Median: $21,224 (150% 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 - $206,727	25%
Bright Health	$12,671	90%
Humana	$13,206 - $29,669	94%
Coventry Altius	$13,481	95%
Cigna	$13,756 - $55,225	97%
Molina Healthcare	$13,756 - $17,646	97%
State Of Utah	$13,756	97%
Triwest Healthcare Alliance	$13,756	97%
University Of Ut	$13,756	97%
Veteran'S Administration	$13,756	97%
Blue Cross Blue Shield	$13,894	98%
Sterling Life Insurance	$14,719	104%
Molina	$15,065	107%
Regence	$17,200 - $28,545	122%
Health Choice	$17,558	124%
Hosp Uncompensated Care	$17,558	124%
Elap	$20,316	144%
Angle Insurance	$21,224	150%
University Of Utah	$24,501 - $32,747	174%
Pehp	$30,278 - $38,324	214%
Multiplan	$34,360	243%
Motivhealth	$36,568	259%
Dmba (Deseret Mutual Benefit Admin)	$38,059	270%
Imagine Health Wise	$39,575	280%

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 Lone Peak 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.