Sepsis treatment (inpatient stay)
Facility: Wamego Health Center
Billing Code: 871 (MS-DRG)
- CPT Billing Code: 871
- Insurance Median: $8,212
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.58x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| UnitedHealthcare | $7,821 | 55% |
| Medicaid / KanCare | $8,134 - $8,212 | 58% |
| Aetna | $14,351 | 102% |
| Blue Cross Blue Shield | $22,581 - $23,769 | 160% |
Consumer Guidance & Cost Commentary
For the procedure "Sepsis treatment (inpatient stay)" at Wamego Health Center in Wamego, KS, the negotiated rates vary significantly depending on your insurance plan. While Medicaid / KanCare plans have a median negotiated rate of $8,212, commercial payers like Blue Cross Blue Shield have higher rates ranging from $22,581 to $23,769. It is important to compare these commercial rates against the Medicare benchmark of $14,116.91, which serves as the objective baseline for healthcare costs. Commercial negotiated rates often exceed the Medicare rate by 200% to 300%, whereas fair pricing is typically defined as 120% to 150% of the Medicare amount. Patients should be aware that assuming an in-network rate is the lowest possible price can be misleading, as different insurers negotiate different maximums, and some facilities may charge significantly more than others for the same service.
If you do not have insurance or have a high-deductible plan, paying cash directly might result in a lower total cost than using insurance, especially if the insurance negotiated rate exceeds the cash price. Wamego Health Center, a Critical Access Hospital, may offer prompt-pay discounts or self-pay rates that reduce the bill by 20% to 50% if you pay in full upfront, bypassing the administrative overhead and collection fees associated with insurance billing. Before scheduling, it is crucial to request a self-pay classification and ask about these discounts directly, as billing systems often default to insurance processing once a card is on file. Additionally, if you receive care from an out-of-network provider, you may face balance billing