CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Sisters of Charity Hospital

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $5,929
Cash Discount Price: $25,095
vs. Medicare Baseline: 0.42x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Sisters of Charity Hospital is $5,929. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25,095. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 0.42x the Medicare baseline. Located in 2157 Main Street, Buffalo, NY.

Cash / Self-Pay

$25,095

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,929

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: $25,095 (178%)

Insurance Median: $5,929 (42%)

Cash: $25,095 (178% of Medicare)

Ins. Median: $5,929 (42% 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
Beacon Essential [350122]	$3,679 - $4,016	26%
Medicaid / KanCare	$3,952 - $14,782	28%
Molina Essential [100167]	$3,952	28%
Fidelis Essential [100163]	$3,952 - $4,201	28%
Independent Health Essential [100166]	$3,952 - $4,992	28%
Amerigroup [350102]	$3,952	28%
Blue Cross Blue Shield	$3,952 - $14,782	28%
UnitedHealthcare	$3,952 - $36,664	28%
Univera Healthcare Essential [100170]	$3,952	28%
Beacon Health Options [100023]	$4,016	28%
Beacon Health Options Alt [100024]	$4,016	28%
Excellus Rochester McD [350117]	$4,201	30%
Tuscarora Nation [550120]	$4,201	30%
Crime Victims [100176]	$4,201	30%
No Fault [114001]	$5,929	42%
Workers Compensation [500101]	$5,929	42%
Fidelis Exchange [100164]	$6,127	43%
Mvp Healthcare [100168]	$6,264	44%
Independent Health [100165]	$7,889 - $12,307	56%
Univera Healthcare [100169]	$8,135 - $11,621	58%
Iha First Choice [800001]	$9,719	69%
Champ VA [700002]	$14,631	104%
Tricare	$14,631	104%
VA Veterans Affairs [700001]	$14,631 - $14,782	104%
Medicare (plans)	$14,782	105%
Wellcare [450129]	$14,782	105%
Cigna	$14,782	105%
Federal Workers Compensation [500100]	$14,782	105%
Catholic Health Life Pace [400005]	$14,782	105%
Covid19 Hrsa [45013]	$14,782	105%
Wellcare Fidelis Dual [450451]	$14,782	105%
Fallon Health [450115]	$14,782	105%
Seneca Nation [450119]	$14,782	105%
Aetna	$14,782	105%
Fidelis Dual Advantage [450120]	$14,782	105%
UPMC Health Plan [100181]	$34,563	245%
Ghi [100153]	$37,987	269%

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 $25,095.
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 Sisters of Charity 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.