CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $21,357
Cash Discount Price: $10,373
vs. Medicare Baseline: 1.51x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Carilion Stonewall Jackson Hospital is $21,357. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,373. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.51x the Medicare baseline. Located in 1 Health Circle, Lexington, VA.

Cash / Self-Pay

$10,373

Average discount available for prompt cash payment at this facility.

Insurance Median

$21,357

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: $10,373 (73%)

Insurance Median: $21,357 (151%)

Cash: $10,373 (73% of Medicare)

Ins. Median: $21,357 (151% 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	$5,596 - $6,216	40%
UnitedHealthcare	$14,848 - $24,226	105%
Aetna	$15,086 - $19,679	107%
Sentara Health Plan	$18,375	130%
Vhn - Ultra	$18,375	130%
Gateway - Tier 3	$20,154	143%
Connecticare	$20,746	147%
Gateway - Tier 2	$23,710	168%
Vhn - Plus	$23,710	168%
Cigna	$23,740	168%
Integrated Health Plan	$25,192	178%
Vhn	$25,192	178%
Vhn - Link	$26,674	189%
Beech Street	$27,267	193%
Gateway - Tier 1	$28,156	199%
Vhn - Secondary Payors	$28,156	199%
Humana	$49,508	351%

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 $10,373.
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 Stonewall Jackson 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.