CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Carilion Medical Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $48,704
Cash Discount Price: $25,720
vs. Medicare Baseline: 3.45x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Carilion Medical Center is $48,704. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25,720. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 3.45x the Medicare baseline. Located in 1906 Belleview Avenue, Se, Roanoke, VA.

Cash / Self-Pay

$25,720

Average discount available for prompt cash payment at this facility.

Insurance Median

$48,704

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%)

Cash / Self-Pay: $25,720 (182%)

Insurance Median: $48,704 (345%)

Cash: $25,720 (182% of Medicare)

Ins. Median: $48,704 (345% 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 345% of the Medicare baseline (a markup of 245%). 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
Aetna	$15,593 - $48,794	110%
Humana	$16,256 - $49,508	115%
Blue Cross Blue Shield	$16,920 - $48,704	120%
UnitedHealthcare	$17,086 - $60,066	121%
Sentara Health Plan	$17,418 - $45,561	123%
Vhn - Ultra	$45,561	323%
Cigna	$49,529 - $52,909	351%
Gateway - Tier 3	$49,970	354%
Connecticare	$51,439	364%
Vhn - Plus	$56,583	401%
Gateway - Tier 2	$58,788	416%
Vhn	$58,788	416%
Vhn - Link	$66,136	468%
Gateway - Tier 1	$69,810	495%
Vhn - Secondary Payors	$69,810	495%

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 $25,720.
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 Carilion Medical Center 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.