CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Carilion Tazewell Community Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $23,200
Cash Discount Price: $12,940
vs. Medicare Baseline: 1.64x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Carilion Tazewell Community Hospital is $23,200. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $12,940. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.64x the Medicare baseline. Located in 388 Ben Bolt Avenue, Tazewell, VA.

Cash / Self-Pay

$12,940

Average discount available for prompt cash payment at this facility.

Insurance Median

$23,200

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: $12,940 (92%)

Insurance Median: $23,200 (164%)

Cash: $12,940 (92% of Medicare)

Ins. Median: $23,200 (164% 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
Blue Cross Blue Shield	$4,904 - $18,850	35%
Aetna	$17,372 - $24,549	123%
Humana	$18,111 - $49,508	128%
Allcare	$18,481	131%
UnitedHealthcare	$18,523 - $30,221	131%
Sentara Health Plan	$19,405 - $22,922	137%
Vhn - Ultra	$22,922	162%
Cigna	$23,477 - $25,030	166%
Gateway - Tier 3	$25,141	178%
Connecticare	$25,880	183%
Vhn - Plus	$28,468	202%
Gateway - Tier 2	$29,577	210%
Vhn	$29,577	210%
Integrated Health Plan	$31,426	223%
Vhn - Link	$33,274	236%
Gateway - Tier 1	$35,123	249%
Vhn - Secondary Payors	$35,123	249%
National Provider Network	$35,493	251%

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 $12,940.
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 Tazewell Community 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.