CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Mercyone Clinton Medical Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $14,786
Cash Discount Price: $22,917
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Mercyone Clinton Medical Center is $14,786. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $22,917. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.05x the Medicare baseline. Located in 1410 North 4Th Street, Clinton, IA.

Cash / Self-Pay

$22,917

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,786

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: $22,917 (162%)

Insurance Median: $14,786 (105%)

Cash: $22,917 (162% of Medicare)

Ins. Median: $14,786 (105% 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
Iowa Total Care	$12,476	88%
Medicaid / KanCare	$12,598 - $12,647	89%
Aetna	$14,349	102%
Medicare (plans)	$14,349 - $14,935	102%
Blue Cross Blue Shield	$14,493	103%
UnitedHealthcare	$14,636 - $38,446	104%
Amish Hospital Aid	$19,474	138%
Oscar	$20,749	147%
Ambetter / Centene	$24,599	174%
Claimdoc	$29,431	208%
Nova	$29,431	208%
Geha	$38,446	272%

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 $22,917.
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 Mercyone Clinton Medical Center 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.