CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Othello Community Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $23,279
Cash Discount Price: $28,873
vs. Medicare Baseline: 1.65x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Othello Community Hospital is $23,279. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $28,873. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.65x the Medicare baseline. Located in 315 North 14Th Avenue, Othello, WA.

Cash / Self-Pay

$28,873

Average discount available for prompt cash payment at this facility.

Insurance Median

$23,279

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: $28,873 (205%)

Insurance Median: $23,279 (165%)

Cash: $28,873 (205% of Medicare)

Ins. Median: $23,279 (165% 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
Chp Mcr Adv	$20,364	144%
Health Alliance Mcr Adv - All Plans	$20,364	144%
Humana	$20,364	144%
Medicare (plans)	$20,364	144%
Molina Mcare	$20,364	144%
UnitedHealthcare	$20,364 - $25,023	144%
Wellcare Mcr Adv - All Plans	$20,364	144%
Blue Cross Blue Shield	$20,403	145%
Ambetter / Centene	$23,075 - $23,483	163%
Amerigroup Mcaid	$23,075	163%
Chp Mcaid	$23,075	163%
Cocare - All Plans	$23,075	163%
Gau - All Plans	$23,075	163%
Kaiser - All Plans	$23,075	163%
Molina Mcaid	$23,075	163%
Chp - All Other Plans	$23,483	166%
Molina - All Other Plans	$23,483	166%
Tricare	$25,023	177%
Triwest - All Plans	$25,023	177%
Asuris - All Plans	$30,798	218%
Commercial Other - All Plans	$30,798	218%
Hma - All Plans	$30,798	218%
Hmso - All Plans	$30,798	218%
Tpsc - All Plans	$30,798	218%
Travelers - All Plans	$30,798	218%
Veterans Admin - All Plans	$30,798	218%
Cigna	$34,262	243%
First Choice - All Plans	$34,647	245%
Aetna	$36,187	256%

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 $28,873.
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 Othello 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.