CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: St Josephs Community Hospital West Bend

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $35,567
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.52x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at St Josephs Community Hospital West Bend is $35,567. 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 2.52x the Medicare baseline. Located in 3200 Pleasant Valley Road, West Bend, WI.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$35,567

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: $35,567 (252%)

Ins. Median: $35,567 (252% 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 252% of the Medicare baseline (a markup of 152%). 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
Allwell	$13,814	98%
Blue Cross Blue Shield	$13,814 - $60,456	98%
Community Care	$13,814	98%
Health Partners	$13,814 - $39,576	98%
Humana	$13,814	98%
Icare	$13,814	98%
Molina	$13,814	98%
Network Health Plan	$13,814 - $36,422	98%
Security Health Plan Secure Savers	$13,814	98%
UnitedHealthcare	$13,814 - $57,234	98%
Aetna	$14,090	100%
Care Wisconsin	$14,229	101%
Chorus Community Health Plan	$35,567	252%
Froedtert South	$35,787	254%
Centivo	$36,210 - $43,823	257%
Sheboygan Employers Health Network	$42,968	304%
Wisconsin Physician Services	$50,905	361%

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 St Josephs Community Hospital West Bend 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.